Preoperative weight loss may not improve outcomes after TKA
Key takeaways:
- Preoperative weight loss of greater than 20 pounds prior to TKA may not decrease postoperative risks.
- Preoperative weight loss of 10 to 20 pounds was associated with an increased risk for PJI after TKA.
SAN DIEGO — Preoperative weight change did not impact outcomes after total knee arthroplasty, according to results presented here.
“Few patients with obesity lost substantial weight before primary TKA, and reaching common preoperative weight loss goals was not associated with improved outcomes,” Charles P. Hannon, MD, MBA, orthopedic surgeon at the Mayo Clinic in Rochester, Minnesota, told Healio about results presented at American Academy of Orthopaedic Surgeons Annual Meeting. “Although a healthy weight is important for general health, weight loss before TKA may not be sufficient to improve postoperative outcomes for most patients with obesity.”
Hannon and colleagues retrospectively reviewed data from 3,665 patients who underwent TKA between 2002 and 2019 with a BMI of 30 kg/m2 or greater, based on measurements collected 1 month to 24 months prior to surgery. Patient weight was also measured at the time of surgery to determine if weight change prior to surgery impacted postoperative TKA outcomes.
According to Hannon, 41% of patients with obesity lost weight and 20% gained weight prior to TKA.
Hannon said preoperative weight loss of greater than 20 pounds was not associated with decreased postoperative risks for revision, reoperation, periprosthetic joint infection, complications, increased operative time, increased length of stay or discharge disposition vs. patients who maintained their preoperative weight. In addition, he noted that weight loss of 10 to 20 pounds was associated with an increased risk for PJI.
“Many institutions, payers, practices and surgeons have BMI cutoffs prior to total knee arthroplasty,” Hannon said. “The results from this study suggest that these cutoffs may not be achievable for many patients, but, more importantly, losing weight and reaching these cutoffs may not necessarily improve outcomes.”
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Seward M, et al. Paper 100. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; March 10-14, 2025; San Diego.
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