Foreman C, et al. - In this study, researchers retrospectively reviewed 158 new patients with BMI ≥ 40 kg/m² and moderate/severe osteoarthritis (OA) of the hip or knee, to determine their course of treatment. Further, they sought for decision criteria that influenced arthroplasty surgeons recommendation regarding non-operative management vs total joint arthroplasty (TJA). In addition, TJA outcomes in this population were compared with those of cases with BMI < 40 kg/m². Using the arthroplasty database, they identified 1,473 patients who underwent TJA during 2016-2018. A majority of patients with BMI ≥ 40 kg/m² and moderate/advanced OA did not return for a second clinic visit. They identified a greater chance of retention in care, and ultimately surgery in relation to relatively lower BMI, but this BMI had no influence on surgeons’ recommendations to continue orthopaedic management. They suggest performing TJA on patients who persist in seeking treatment, lose significant weight, and exhaust non-operative alternatives, despite a BMI ≥ 40 kg/m²; an overall complication rate was 4.3% for these patients. However, BMI < 40 kg/m² was achieved only in 9% of patients at 2-year follow-up; of these, only 20% had undergone surgeries.