Obesity and type 2 diabetes mellitus are established risk factors for osteoarthritis and are associated with worse outcomes following primary total hip arthroplasty (THA) and total knee arthroplasty (TKA). Glucagon-like peptide-1 receptor agonists (GLP-1a) are therapies that improve glycaemic control and promote weight loss; their perioperative impact on arthroplasty outcomes has been of growing interest. The study summarized here aimed to assess the association between GLP-1a treatment and 90-day surgical complications following primary THA and TKA.
The authors performed a systematic review according to PRISMA guidelines. Studies were eligible if they reported at least one outcome of interest after primary THA or TKA and involved patients prescribed a GLP-1a for type 2 diabetes or for weight loss in obesity. The primary outcome was the combined 90-day surgical complication rate for THA and TKA. The predefined 90-day surgical complications included periprosthetic joint infection (PJI), wound dehiscence, periprosthetic fracture (PPF), haematoma, nerve injury, or surgical site infection (SSI).
Secondary outcomes were 90-day medical complications, 90-day readmission rates, all-cause revision (reported at up to two years in included studies), healthcare costs, and length of hospital stay.
From 78 studies reviewed, ten matched cohort studies met inclusion criteria and were pooled for analysis. The combined sample comprised 96,356 patients: 30,350 who underwent THA and 66,606 who underwent TKA. The mean age across cohorts was 61.9 years and 60.1% of patients were female (n = 57,939). In all included studies, a GLP-1a had been prescribed either for management of type 2 diabetes mellitus or for weight loss in obese patients.
Pooled analysis showed a lower rate of 90-day surgical complications in patients exposed to a GLP-1a, with a pooled risk ratio (RR) of 0.73. The surgical complications considered in this endpoint were the composite of PJI, wound dehiscence, PPF, haematoma, nerve injury, and SSI as defined by the review.
Use of a GLP-1a was associated with lower 90-day medical complications (RR 0.78) and reduced 90-day readmission rates (RR 0.79). Statistical heterogeneity for readmissions was reported (I2 = 61.6%). Reported two-year all-cause revision rates in the included studies ranged from 1.7% to 3.3% for the GLP-1a cohorts and from 1.7% to 4.5% for control cohorts. The GRADE assessment found confidence in the healthcare cost outcome to be moderate; for most other outcomes the GRADE confidence was very low. The abstract notes a potential association between GLP-1a use and substantial cost savings, but detailed cost data and length-of-stay results are not provided in the abstract.
A prespecified subgroup analysis separating THA and TKA outcomes showed differential associations. In the THA subgroup, GLP-1a exposure 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 the TKA subgroup, the only statistically significant association reported was a lower 90-day readmission rate (RR 0.77). The abstract does not provide additional subgroup-specific numerical data beyond these RRs.
Of the ten included matched cohort studies, two were judged to have a serious overall risk of bias and eight had a moderate risk of bias. The authors applied the GRADE framework: confidence in evidence was rated very low for most outcomes except healthcare cost (moderate). Heterogeneity was quantified at least for readmissions (I2 = 61.6%), indicating moderate-to-substantial between-study variability for that endpoint.
Based on the pooled matched cohort data included in this review, perioperative or preoperative treatment with a GLP-1 receptor agonist was associated with reductions in 90-day surgical complications, 90-day medical complications, and 90-day readmissions in a combined cohort of primary THA and TKA patients, particularly among high-risk diabetic and obese patients. Subgroup results suggest a stronger association for THA than for TKA. The authors propose that GLP-1a use may also be associated with healthcare cost savings, supported by a moderate GRADE rating for cost outcomes in the abstract.
The abstract reports several limitations relevant to interpretation: the included studies were matched cohort designs (no randomized controlled trials described in the abstract), risk-of-bias concerns (two studies with serious risk, eight with moderate risk), and overall low GRADE confidence for most outcomes. Specific methodological details of individual studies, detailed cost analyses, and granular intervention timing or dosing schedules were not reported in the abstract. These gaps constrain causal inference and the ability to define optimal perioperative prescribing strategies from the available summary.
The findings reported in this systematic review and meta-analysis indicate a potentially beneficial association between GLP-1a therapy and early postoperative outcomes after THA and TKA in high-risk populations. However, clinicians should interpret the pooled associations in the context of the observational nature of included studies, variable risk of bias, and low overall certainty for most outcomes as reported in the source abstract.