A recent study led by Epaminondas Markos Valsamis from the University of Oxford indicates that obese patients undergoing shoulder replacement surgery do not face an increased risk of complications or death. Published in the open-access journal PLOS Medicine, this research challenges existing assumptions about the safety of elective surgeries for patients with higher body mass index (BMI).
Joint replacement surgeries, including those for the shoulder, hip, and knee, are known to significantly enhance patients’ quality of life. Despite this, many individuals with obesity are often denied these procedures due to concerns over their safety. Notably, there are currently no formal guidelines from national organizations recommending such restrictions. The evidence regarding the risks associated with joint replacement surgery in obese patients has been limited and sometimes contradictory.
In this analysis, researchers examined over 20,000 elective shoulder replacement surgeries conducted in the UK and Denmark. They sought to determine the relationship between BMI and postoperative outcomes, particularly mortality and complications. The findings were striking: patients with obesity, defined as having a BMI of 40 kg/m², demonstrated a 60% lower risk of death within the year following surgery compared to those with a healthy BMI of 21.75 kg/m². Interestingly, individuals classified as underweight (BMI <18.5 kg/m²) faced a slightly elevated risk of mortality. Despite the study's significant findings, it does highlight a limitation regarding the underweight population, which consisted of only 131 individuals from the UK and 70 from Denmark. Nevertheless, the overall robust data consistently indicated lower risks for obese patients undergoing shoulder replacement across various outcomes in both countries.
The implications of this research are considerable for patients, surgeons, and policymakers. Epaminondas Markos Valsamis stated, “Shoulder replacements offer patients the opportunity for excellent pain relief and improved quality of life. Our research shows that patients with a higher BMI do not have poorer outcomes after shoulder replacement surgery.”
In light of these findings, Professor Jonathan Rees, the senior author, emphasized that “while BMI thresholds have been used to limit access to joint replacement surgery, our findings do not support restricting higher BMI patients from accessing shoulder replacement surgery.”
This study serves as an important resource for guiding future surgical decisions, potentially leading to more inclusive practices for patients with obesity. As medical professionals continue to assess the criteria for elective surgeries, the evidence presented could reshape policies and improve accessibility for those in need of surgical intervention.
For more information, refer to the study: Valsamis EM, et al. The association of body mass index with patient outcomes after shoulder replacement surgery: Population-based cohort study using linked national data from the United Kingdom and Denmark. PLOS Medicine (2025). DOI: 10.1371/journal.pmed.1004786.
