Obesity accelerates the development of osteoarthritis of the knee and hip by exerting
deleterious effects on joints through both biomechanical and also systemic inflammatory
changes. The objective of this review was to evaluate the impact of obesity on lower
limb biomechanics and total joint arthroplasty outcomes, as well as weight changes
after joint arthroplasty and the role of bariatric surgery among patients requiring
joint arthroplasty. The currently published data indicate that weight loss increases
swing time, stride length, gait speed, and lower extremity range of motion. Total
joint arthroplasty improves pain and joint function, but does not induce significant
weight loss in the majority of patients. Bariatric surgery improves gait biomechanics,
and in the severely obese patient with osteoarthritis improves pain and joint function.
The evidence for supporting bariatric surgery before total joint arthroplasty is limited
to retrospective reports with conflicting results. Fundamental clinical questions
remain regarding the optimal management of morbid obesity and lower extremity arthritis,
which should be the focus of future collaborations across disciplines providing care
to patients with both conditions.