---
title: "GLP-1 Receptor Agonists Linked to Fewer 90-Day Complications After Total Hip and Knee Arthroplasty"
id: "pubmed-42538001"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42538001"
content_type: "clinical_feed_article"
specialty: "Pharmacology"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42538001/"
doi: "10.1302/0301-620X.108B8.BJJ-2025-1486.R2"
published_at: "2026-08-01T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# GLP-1 Receptor Agonists Linked to Fewer 90-Day Complications After Total Hip and Knee Arthroplasty
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42538001
- **Specialty:** [Pharmacology](https://medichelpline.com/clinical-feed/pharmacology.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42538001/)
- **DOI:** [10.1302/0301-620X.108B8.BJJ-2025-1486.R2](https://doi.org/10.1302%2F0301-620X.108B8.BJJ-2025-1486.R2)
- **Published At:** 2026-08-01T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- This systematic review and meta-analysis examined the association between **glucagon-like peptide-1 receptor agonists (GLP-1a)** and 90-day outcomes after primary total hip arthroplasty (THA) and total knee arthroplasty (TKA). - Ten matched cohort studies were included from 78 reviewed records, totaling 96,356 patients (30,350 THA; 66,606 TKA). - Mean patient age was 61.9 years; 60.1% were female. GLP-1as were prescribed for type 2 diabetes or weight loss in obese patients in the included studies. - Primary outcome: pooled 90-day surgical complications were lower in the GLP-1a group (pooled RR 0.73). Defined surgical complications included PJI, wound dehiscence, PPF, haematoma, nerve injury, and SSI. - Secondary outcomes: 90-day medical complications (RR 0.78) and 90-day readmissions (RR 0.79; I2 = 61.6%) were lower with GLP-1a exposure; two-year revision rates ranged 1.7–3.3% for GLP-1a patients versus 1.7–4.5% for controls. - Subgroup analysis showed stronger associations for **THA**, with reduced 90-day surgical complications (RR 0.63), medical complications (RR 0.55), and readmissions (RR 0.82). For **TKA**, only 90-day readmissions were significantly lower (RR 0.77). - Risk of bias: two studies had serious overall risk; eight had moderate risk. GRADE confidence was very low for most outcomes, except healthcare cost (moderate). - Authors conclude GLP-1a treatment before THA and TKA potentially reduces early surgical and medical complications and readmissions in high-risk diabetic and obese patients and may yield cost savings. - Details such as individual study interventions, exact follow-up protocols, and granular cost data were not reported in the provided abstract.
## Clinical Analysis & Structured Key Points
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Affiliations Expand ### Affiliations * 1 Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK. * 2 Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK. * 3 NIHR Biomedical Research Centre at University Hospitals Bristol and Weston NHS Foundation Trust, University of Bristol, Bristol, UK. * 4 NIHR Applied Research Collaboration South West and the University of Bristol, UK, University of Bristol, Bristol, UK. * 5 Hospital for Special Surgery, New York, New York, USA. * PMID: **42538001** * DOI: [ 10.1302/0301-620X.108B8.BJJ-2025-1486.R2 ](https://doi.org/10.1302/0301-620x.108b8.bjj-2025-1486.r2) Item in Clipboard Meta-Analysis # Glucagon-like peptide-1 receptor agonists are associated with improved 90-day outcomes after total hip and knee arthroplasty : a systematic review and meta-analysis Branavan Rudran et al. Bone Joint J. 2026. Show details Display options Display options Format Abstract PubMed PMID Bone Joint J Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Bone+Joint+J%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Bone+Joint+J%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42538001/) . 2026 Aug 1;108-B(8):986-994. doi: 10.1302/0301-620X.108B8.BJJ-2025-1486.R2. ### Authors [Branavan Rudran](https://pubmed.ncbi.nlm.nih.gov/?term=Rudran+B&cauthor_id=42538001)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42538001/#short-view-affiliation-1 "Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK."), [Christopher D J Little](https://pubmed.ncbi.nlm.nih.gov/?term=Little+CDJ&cauthor_id=42538001)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42538001/#short-view-affiliation-1 "Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK."), [Antony J R Palmer](https://pubmed.ncbi.nlm.nih.gov/?term=Palmer+AJR&cauthor_id=42538001)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42538001/#short-view-affiliation-1 "Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK."), [Andrew Judge](https://pubmed.ncbi.nlm.nih.gov/?term=Judge+A&cauthor_id=42538001)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42538001/#short-view-affiliation-1 "Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42538001/#short-view-affiliation-2 "Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.")[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42538001/#short-view-affiliation-3 "NIHR Biomedical Research Centre at University Hospitals Bristol and Weston NHS Foundation Trust, University of Bristol, Bristol, UK.")[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42538001/#short-view-affiliation-4 "NIHR Applied Research Collaboration South West and the University of Bristol, UK, University of Bristol, Bristol, UK."), [Alberto Carli](https://pubmed.ncbi.nlm.nih.gov/?term=Carli+A&cauthor_id=42538001)[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42538001/#short-view-affiliation-5 "Hospital for Special Surgery, New York, New York, USA."), [Andrew J Price](https://pubmed.ncbi.nlm.nih.gov/?term=Price+AJ&cauthor_id=42538001)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42538001/#short-view-affiliation-1 "Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK."), [Abtin Alvand](https://pubmed.ncbi.nlm.nih.gov/?term=Alvand+A&cauthor_id=42538001)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42538001/#short-view-affiliation-1 "Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.") ### Affiliations * 1 Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK. * 2 Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK. * 3 NIHR Biomedical Research Centre at University Hospitals Bristol and Weston NHS Foundation Trust, University of Bristol, Bristol, UK. * 4 NIHR Applied Research Collaboration South West and the University of Bristol, UK, University of Bristol, Bristol, UK. * 5 Hospital for Special Surgery, New York, New York, USA. * PMID: **42538001** * DOI: [ 10.1302/0301-620X.108B8.BJJ-2025-1486.R2 ](https://doi.org/10.1302/0301-620x.108b8.bjj-2025-1486.r2) Item in Clipboard Cite Display options Display options Format Abstract PubMed PMID ## Abstract **Aims:** Obesity and diabetes are risk factors for developing osteoarthritis and associated with worse outcomes following total hip (THA) and total knee arthroplasty (TKA). Glucagon-like peptide-1 receptor agonists (GLP-1as) improve glycaemic control and promote weight loss. The aim of this study was to assess the impact of GLP-1a treatment on 90-day surgical complications following THA and TKA. **Methods:** A systematic review was undertaken according to PRISMA guidelines. Studies were included if they reported at least one outcome of interest following primary THA or TKA. In all the studies which were included, a GLP-1a was prescribed for the management of type 2 diabetes mellitus or for weight loss in obese patients. The primary outcome was the 90-day surgical complication rate in the combined THA and TKA cohort. The 90-day surgical complications were defined as: periprosthetic joint infection (PJI), wound dehiscence, periprosthetic fracture (PPF), haematoma, nerve injury, or surgical site infection (SSI). Secondary outcomes included 90-day medical complications and readmission rates, all-cause revision, healthcare costs, and length of stay. **Results:** A total of 78 studies were reviewed, and ten matched cohort studies with a total of 96,356 patients (30,350 THAs and 66,606 TKAs) were included. The mean age of the patients was 61.9 years; 60.1% female (n = 57,939). Two studies had a serious risk of overall bias and eight had a moderate risk. The confidence of evidence according to the GRADE assessment was very low for all but one outcome measure (healthcare cost: moderate). The rate of 90-day surgical complications was lower in the GLP-1a cohort (pooled risk ratio (RR) 0.73). The use of a GLP-1a lowered the 90-day medical complications and readmission rates (RR 0.78 and RR 0.79 (I2 = 61.6%), respectively). At two years, the revision rate ranged from 1.7% to 3.3% for the GLP-1a cohort and 1.7% to 4.5% for the controls. Sub-group analysis showed a stronger association in the THA group, in which the use of a GLP-1a was associated with significantly lower rates of 90-day surgical complications (RR 0.63), 90-day medical complications (RR 0.55), and 90-day readmissions (RR 0.82). In contrast, the use of a GLP-1a in the TKA group was only sigificantly associated with a lower 90-day readmission rate (RR 0.77). **Conclusion:** GLP-1a treatment before THA and TKA potentially reduces the 90-day surgical and medical complications and 90-day readmission rates in high-risk diabetic and obese patients. The use of a GLP-1a may also be associated with substantial cost savings. © 2026 The British Editorial Society of Bone & Joint Surgery. [PubMed Disclaimer](https://pubmed.ncbi.nlm.nih.gov/disclaimer/) ## Conflict of interest statement A. Judge reports grants or contracts from NIHR, HDR UK, Versus Arthritis, Healthcare Quality Improvement Partnership (HQIP), Royal College of Physicians (RCP), Tommy’s, and the Health Foundation, participates on a range of Data Safety Monitoring or Advisory Boards, and was co-chair Versus Arthritis Research Expert group from September 2022 to October 2025, all of which are unrelated to this study. A. Price reports consulting fees from Zimmer Biomet and Medacta, unrelated to this study. A. Alvand reports royalties or licenses from Adler Orthopaedics, consulting fees from Medacta International, Adler Orthopedics, BD, Solventum, Smith & Nephew, payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Ethicon, Zimmer Biomet, Medacta, Adler Ortho, Solventum, Molnlycke, Biocomposites, participation on a Data Safety Monitoring Board or Advisory Board for BD and Smith & Nephew, and stock or stock options with PSI, all of which are unrelated to this study. ## References 1. 1. Ng M , Gakidou E , Lo J , et al. Global, regional, and national prevalence of adult overweight and obesity, 1990–2021, with forecasts to 2050: a forecasting study for the Global Burden of Disease Study 2021 . Lancet . 2025 ; 405 ( 10481 ): 813 – 838 . 10.1016/S0140-6736(25)00355-1 40049186 2. 1. No authors listed . Adult Obesity Facts . Centers for Disease Control and Prevention . 2024 . ( date last accessed 1 July 2026 ). 3. 1. Rizzo EA , Phillips RD , Brown JT , Leary EV , Keeney JA . Obesity severity predicts patient dissatisfaction after total knee arthroplasty . J Arthroplasty . 2023 ; 38 ( 12 ): 2492 – 2496 . 10.1016/j.arth.2023.05.063 37276951 4. 1. Ward ZJ , Bleich SN , Cradock AL , et al. Projected U.S. state-level prevalence of adult obesity and severe obesity . N Engl J Med . 2019 ; 381 ( 25 ): 2440 – 2450 . 10.1056/NEJMsa1909301 31851800 5. 1. Egerci OF , Yapar A , Dogruoz F , Selcuk H , Kose O . Preventive strategies to reduce the rate of periprosthetic infections in total joint arthroplasty; a comprehensive review . Arch Orthop Trauma Surg . 2024 ; 144 ( 12 ): 5131 – 5146 . 10.1007/s00402-024-05301-w 38635048 Show all 31 references ## Publication types * Systematic Review Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Systematic+Review%22%5Bpt%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Systematic+Review) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42538001/) * Meta-Analysis Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Meta-Analysis%22%5Bpt%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Meta-Analysis) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42538001/) ## MeSH terms * Arthroplasty, Replacement, Hip* / adverse effects Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Arthroplasty%2C+Replacement%2C+Hip%2Fadverse+effects%22%5BMAJR%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Arthroplasty%2C+Replacement%2C+Hip) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42538001/) * Arthroplasty, Replacement, Knee* / adverse effects Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Arthroplasty%2C+Replacement%2C+Knee%2Fadverse+effects%22%5BMAJR%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Arthroplasty%2C+Replacement%2C+K
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