The effect of obesity on the outcomes of total joint arthroplasties is an ongoing concern. As obesity becomes more endemic, new categories emerge, such as the “super-obese.” We conducted a retrospective study to determine the difference in outcomes among the super-obese. When categorized according to body mass index (BMI), the overall rate of complications was higher for patients with BMI of 45 or higher. Super-obese patients had an odds ratio (OR) of 8.44 for developing inhospital complications. Most importantly, each incremental 5-U increase in BMI above 45 was associated with an increased risk of inhospital (OR, 1.69) and outpatient complications (OR, 2.71), and readmission (OR, 2.0), compared with patients with BMI of 45 to 50. Length of stay was increased by 13.8% for each 5-U increase in BMI above 45. There is a significant increased risk for complications in the super-obese population, and this continues to increase with BMI increases above 45. These data are important when counseling super-obese patients and should be accounted for in reporting quality outcome measures in this population.