Question (A) What upper body mass index (BMI) threshold is associated with an increased risk of surgical site infection/periprosthetic joint infection (SSI/PJI)? (B) Does implementation of these cutoffs reduce the incidence of SSI/PJI?

Authors: Stuart Goodman, Ruben Limas, Derek F. Amanatullah, Katherine Hwang


A) Obesity increases the risk of SSI/PJI after total joint arthroplasty (TJA). The risk increases gradually throughout the full range of BMI rather than surging at a certain cutoff point. A substantially increased risk is noticed in patients with a BMI > 40 Kg/m2 and the risks of surgery must be carefully weighed against its benefits in these patients.

B) Weight reduction prior to surgery may have a benefit in mitigating risk for SSI/PJI for all patients with a BMI above normal.

LEVEL OF EVIDENCE: A) Strong, B) Consensus

DELEGATE VOTE: Agree: 95%, Disagree: 2%, Abstain: 3% (Unanimous, Strongest Consensus)