J Knee Surg 2018; 31(01): 038-042
DOI: 10.1055/s-0037-1608933
Special Focus Section
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Effect of Obesity on Total Knee Arthroplasty Costs and Revision Rate

Martin Roche1, Tsun Yee Law1, Jennifer Kurowicki1, 2, Samuel Rosas1, 3, Augustus J. Rush III4
  • 1Department of Orthopedic Surgery, Holy Cross Orthopedic Research Institute, Fort Lauderdale, Florida
  • 2Department of Orthopaedic Surgery, Seton Hall University, School of Health and Medical Sciences, South Orange, New Jersey
  • 3Department of Orthopedic Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina
  • 4Department of Orthopedic Surgery, University of Miami/Jackson Memorial Hospital, Miami, Florida
Further Information

Publication History

26 September 2017

07 November 2017

Publication Date:
07 December 2017 (eFirst)


An increasing number of total knee arthroplasties (TKAs) are performed on obese patients. It is imperative to remain up to date on the effect of obesity on surgical outcomes and reimbursement trends. The purpose of this study was to evaluate the impact different severities of obesity have on primary and revision TKA, specifically: (1) incidence and trends over time; (2) annual growth rate; and (3) admission costs from 2010 to 2014. A retrospective review of a large commercial private payer database within the PearlDiver Supercomputer application (Warsaw, IN) of TKA procedures was conducted. Patients who underwent TKA and subsequent revision were identified by Current Procedural Terminology (CPT) and ninth revision International Classification of Disease (ICD-9) codes. The index procedure was linked with ICD-9 codes for body mass indexes (BMIs) from <19 to >70. Statistical analysis was primarily descriptive to demonstrate the revision incidence and reimbursement deviations due to BMI. Compound annual growth rate (CAGR) was also calculated. Our query returned a total of 87,607 TKA patients within the study BMI ranges. The majority of patients had a BMI of 40 to 44.9 (12.2%) and least in the BMI >70 (0.2%) range. BMI of 40 to 44.9 had the highest overall 5-year mean reimbursement of $11,521 and the highest overall mean 5-year deviation from normal BMI (19–24) patients of $3,300. The incidence and burden of TKA revision was highest in patients with a BMI of 60 to 69.9 (21 and 17.3%, respectively). Average 5-year revision reimbursement and deviation from normal BMI (19–24) was highest in patients with a BMI of 40 to 44.9 ($13,883 and $4,030, respectively). The number of obese patients receiving TKA is steadily rising. The cost of treating obese patients rises as BMI deviates from normal, as does the incidence of revision surgery. Therefore, surgeons must be active in counseling patients on weight optimization as part of preoperative standard of care.