JOA - 2026-06-01 - Journal Article; Systematic Review; Meta-Analysis
The Impact of Glucagon-Like Peptide-1 Receptor Agonist Use on Clinical Outcomes After Total Hip and Knee Arthroplasty: A Systematic Review and Meta-Analysis of 346,899 Patients.
Lee S, Singh K, Clark SC, Goh GS
Topics
Key Takeaway
GLP-1RA use was associated with reduced 90-day PJI risk after TKA (OR 0.75), reduced 90-day revision after THA (OR 0.76), and decreased readmissions, but carried an elevated myocardial infarction risk after TKA (OR 1.39) across 346,899 patients.
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Summary
This systematic review and meta-analysis evaluated GLP-1RA use on perioperative outcomes following THA and TKA across 13 studies queried through June 2025. GLP-1RA use was associated with lower 90-day PJI risk in TKA (OR 0.75, 95% CI 0.57–1.00), lower 90-day revision in THA (OR 0.76, 95% CI 0.59–0.98), and reduced readmission rates in both procedures. However, GLP-1RA use was associated with increased myocardial infarction risk in TKA patients (OR 1.39, 95% CI 1.05–1.85), and no significant aspiration or pneumonia risk was identified (OR 1.09, P=0.70).
Key Limitation
All 13 included studies are observational with inherent confounding by indication — patients prescribed GLP-1RAs likely differ systematically in baseline metabolic health, diabetes control, and cardiovascular comorbidity from non-users, making outcome attribution to the drug unreliable.
Original Abstract
BACKGROUND
Obesity and diabetes are highly prevalent comorbidities in patients undergoing total hip (THA) and knee arthroplasty (TKA). Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are novel agents that promote weight loss and glycemic control, assisting with perioperative optimization and potentially improving clinical outcomes. However, there have been safety concerns surrounding GLP-1RA use due to delayed gastric emptying and increased aspiration risk. The purpose of this systematic review was to evaluate the impact of GLP-1RA usage on perioperative outcomes following THA and TKA.
METHODS
PubMed (Medline), Scopus (Embase, Medline, and Compendex), and Cochrane databases were queried to conduct a systematic review of articles from inception to June 2025. A total of 13 studies were included (119,092 hip, 227,381 knee, and 426 hip or knee). Demographics, surgical complications, medical complications, resource utilization, and revision rates were recorded at 90 days and at one and two years. Meta-analysis was performed using a random-effects model.
RESULTS
The GLP-1RA use was associated with a lower risk of 90-days PJI following TKA (odds ratio (OR), 0.75; 95% confidence interval (CI), 0.57 to 1.00; P = 0.047) and a lower risk of 90-day revision following THA (OR, 0.76; 95% CI, 0.59 to 0.98; P = 0.034). There was a significant decrease in 90-day readmission rates for TKA and THA with GLP-1RA use. Of note, no significant association was found between GLP-1RA use and aspiration or pneumonia (OR, 1.09; 95% CI, 0.71 to 1.67; P = 0.70), but GLP-1RA usage was associated with an elevated risk of myocardial infarction in the setting of TKA (OR, 1.39; 95% CI, 1.05 to 1.85; P = 0.02).
CONCLUSIONS
The GLP-1RA use was associated with improved early surgical outcomes and decreased resource utilization following THA and TKA. These findings suggest a potential benefit of GLP-1RA use for optimizing high-risk patients who have obesity or diabetes undergoing total joint arthroplasty.