Associations between weight loss prior to knee and hip arthroplasty and peri- and post-operative outcomes: a systematic review and meta-analysis
File(s)
Supporting information
Author(s)
Type
Journal Article
Abstract
Background
In some of the existing literature, obesity is associated with increased complications in those who undergo lower limb arthroplasty. We conducted a systematic review and meta-analysis to assess if pre-arthroplasty weight loss mitigates increased post-operative risks.
Methods
This systematic review and meta-analysis was registered on PROSPERO (CRD42023431110). Key terms were utilized to search PubMed, EMBASE, Ovid, Web of Science, Google Scholar, and Europe PMC. Peer-reviewed articles published between January 1, 2010, and December 31, 2024, were screened. Studies that reported specific outcomes (superficial wound infection, deep wound infection, pulmonary embolus [PE], deep vein thrombosis [DVT], and revision surgery) in an intervention group (patients with a BMI > 30 kg/m2 who underwent pre-arthroplasty weight loss) and a control group (patients who underwent arthroplasty without preceding weight loss) 90 days post-arthroplasty were selected and data were extracted from studies meeting these inclusion criteria. Data were analyzed using a random effects model.
Findings
Twenty-one articles were included in the meta-analysis. In people with obesity, pre-arthroplasty weight loss was associated with an increased risk of revision surgery in the first 90 days following lower limb arthroplasty (OR 1.37 [1.01–1.84], p = 0.04). Weight loss did not alter the risk of post-operative DVT, PE, superficial wound infections, and deep wound infections.
Conclusions
Our results demonstrate that pre-arthroplasty weight loss does not improve short-term post-operative outcomes in people with obesity. Large, well-designed prospective studies should be performed to provide robust data for the development of evidence-based guidelines for lower limb arthroplasty in people living with obesity.
In some of the existing literature, obesity is associated with increased complications in those who undergo lower limb arthroplasty. We conducted a systematic review and meta-analysis to assess if pre-arthroplasty weight loss mitigates increased post-operative risks.
Methods
This systematic review and meta-analysis was registered on PROSPERO (CRD42023431110). Key terms were utilized to search PubMed, EMBASE, Ovid, Web of Science, Google Scholar, and Europe PMC. Peer-reviewed articles published between January 1, 2010, and December 31, 2024, were screened. Studies that reported specific outcomes (superficial wound infection, deep wound infection, pulmonary embolus [PE], deep vein thrombosis [DVT], and revision surgery) in an intervention group (patients with a BMI > 30 kg/m2 who underwent pre-arthroplasty weight loss) and a control group (patients who underwent arthroplasty without preceding weight loss) 90 days post-arthroplasty were selected and data were extracted from studies meeting these inclusion criteria. Data were analyzed using a random effects model.
Findings
Twenty-one articles were included in the meta-analysis. In people with obesity, pre-arthroplasty weight loss was associated with an increased risk of revision surgery in the first 90 days following lower limb arthroplasty (OR 1.37 [1.01–1.84], p = 0.04). Weight loss did not alter the risk of post-operative DVT, PE, superficial wound infections, and deep wound infections.
Conclusions
Our results demonstrate that pre-arthroplasty weight loss does not improve short-term post-operative outcomes in people with obesity. Large, well-designed prospective studies should be performed to provide robust data for the development of evidence-based guidelines for lower limb arthroplasty in people living with obesity.
Date Issued
2026-05-12
Date Acceptance
2026-04-27
Citation
Obesity Reviews, 2026
ISSN
1467-7881
Publisher
Wiley
Journal / Book Title
Obesity Reviews
Copyright Statement
© 2026 The Author(s). Obesity Reviews published by John Wiley & Sons Ltd on behalf of World Obesity Federation. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
License URL
Identifier
10.1111/obr.70160
Subjects
arthroplasty | bariatric surgery | joint replacement complications | obesity | weight loss BMI, body mass index
CI, confidence interval
DVT, deep vein thrombosis
GLP1-RAs, glucagon-like peptide 1 receptor agonists
NJR, National Joint Registry
OR, odds ratio
PE, pulmonary embolism
SGLT2is, sodium-glucose cotransporter 2 inhibitors
VTE, venous thromboembolism
WHO, World Health Organization
Publication Status
Published online
Article Number
e70160
Date Publish Online
2026-05-12