For patients with obesity, outcomes were similar regardless of whether they lost weight before surgery or not.

Obesity (body mass index [BMI], 30 kg/m² or above) is associated with excess risk for complications after total hip arthroplasty. As a result, many orthopaedic surgeons recommend preoperative weight loss in patients with substantial obesity. Mayo Clinic investigators assessed the effects of preoperative weight loss on postoperative outcomes among 2500 patients with obesity (mean age, 66 years; mean BMI, 35 kg/m²) who were undergoing total hip arthroplasty.

Patients’ weights were measured one to 24 months before surgery and at the time of surgery. Overall, 45% lost more than 2.27 kg (29% lost more than 4.54 kg), 38% stayed at the same weight and 17% gained more than 2.27 kg before surgery. In adjusted analyses, operative time, length of hospital stay and discharge disposition were similar in all groups. After mean follow up of five years, survivorship free of prosthetic joint infection, complications, revisions and reoperation were similar for patients in any weight-loss category compared with patients who stayed at the same weight.

Comment: Preoperative weight loss was not associated with fewer postoperative adverse outcomes among patients with obesity who underwent total hip arthroplasty, although residual confounding still could have played a part. These findings call into question the practice of requiring weight loss before total hip arthroplasty to improve surgical outcomes in patients with obesity. An editorialist concurred, stating, ‘If … the patient is having severe symptoms that cannot be controlled nonoperatively, excess weight should no longer be an argument for delaying surgery.’ A recent guideline, developed jointly by orthopaedic and rheumatology organisations, concurs with this conclusion (NEJM JW Gen Med Dec 1 2023 and Arthritis Care Res [Hoboken] 2023; 75: 2227-2238).

Paul S. Mueller, MD, MPH, FACP, The Dr. Lowell Henry Lebermann Endowed Chair in Internal Medicine and Professor of Internal Medicine, Dell Medical School, University of Texas at Austin, Austin, USA.

Seward MW, et al. Weight loss before total hip arthroplasty was not associated with decreased postoperative risks. J Bone Joint Surg Am 2025; 107: 849-857.

Büchler L. Is it beneficial to delay surgery for weight loss in obese patients before THA? J Bone Joint Surg Am 2025; 107: e38.

This summary is taken from the following Journal Watch titles: General Medicine, Ambulatory Medicine.