Complications of Morbid Obesity in Total Joint Arthroplasty: Risk Stratification Based on BMI

Derek T. Ward, Lionel N. Metz, Patrick K. Horst, Hubert T. Kim, Alfred C. Kuo

Research output: Contribution to journalArticlepeer-review

84 Scopus citations


This study stratifies complication risk in primary total joint arthroplasty (TJA) based on body mass index (BMI). Demographics, co-morbidities, perioperative variables, and complications were reviewed for 22,808 patients. Chi-squared, one-way ANOVA, univariate and multivariable regression analysis were performed. Increasing BMI led to an increase (P < 0.05) in combined complications, acute kidney injury (AKI), cardiac arrest (CA), reintubation, reoperation, and superficial infection (SI). Univariate analysis for BMI > 40 revealed an increase in combined complications (15.21-vs-17.40%), AKI (1.93-vs-3.87%), CA (0.22-vs-0.57%), reintubation (0.47-vs-0.95%), reoperation (2.36-vs-3.37%), and SI (0.82-vs-1.65%). Multivariable regression showed BMI > 40 as an independent predictor for combined complications (OR = 1.18), AKI (OR = 1.79), CA (OR = 3.94), reintubation (OR = 2.56), reoperation (OR = 1.44), and SI (OR = 2.11). Morbid obesity confers increased risk for complications in TJA.

Original languageEnglish (US)
Pages (from-to)42-46
Number of pages5
JournalJournal of Arthroplasty
Issue number9
StatePublished - Sep 1 2015


  • Obesity
  • Postoperative complications
  • Primary total hip arthroplasty
  • Primary total knee arthroplasty
  • Total joint arthroplasty

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