Preoperative GLP-1 RA use before total knee arthroplasty was associated with lower odds of periprosthetic joint infection compared to bariatric surgery (OR 1.70 for BS vs GLP-1 RA).
Cohort (n=10,905)
Does preoperative GLP-1 RA use reduce surgical complications compared to bariatric surgery or no intervention in obese patients undergoing primary total knee arthroplasty?
Preoperative GLP-1 RA use is associated with lower surgical complication rates following total knee arthroplasty compared to bariatric surgery or no weight-loss intervention.
Effect estimate: OR 1.70
Background: Obesity is a risk factor for adverse outcomes following total knee arthroplasty (TKA). Bariatric surgery (BS) and glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are weight-loss strategies commonly encountered in TKA patients. This study aimed to compare short- and long-term complications among obese patients treated with either BS or GLP-1 RAs prior to TKA. Methods: The database was queried to identify patients with obesity (body mass index BMI ≥35 kg/m2) undergoing primary TKA. Patients were stratified based on interventions within 1 year prior to surgery: BS, GLP-1 RA, and no weight-loss intervention. Propensity score matching was performed to balance baseline characteristics. Subgroup analyses were conducted for BMI 35–40 kg/m2 and >40 kg/m2. Primary outcomes included periprosthetic joint infection (PJI), aseptic loosening, periprosthetic fracture, and revision surgery at 90 days, 2 years, and 5 years. Results: In the matched BMI ≥35 kg/m2 cohort (n = 3635 per group), patients with prior BS had significantly higher odds of all surgical complications, including PJI (odds ratio OR: 1.70) and all-cause revision (OR: 1.69) compared to the GLP-1 RA cohort. Compared to the no-intervention cohort, BS was associated with increased risks of PJI (OR: 1.33) and periprosthetic fracture (OR: 2.01). Conversely, the GLP-1 RA cohort showed significantly lower risks of surgical complications compared to the no-intervention cohort across most time points and BMI subgroups. Conclusions: Preoperative GLP-1 RA use is associated with lower complication rates than BS and demonstrates a protective safety profile compared with no weight-loss intervention, underscoring their potential role in preoperative obesity patients undergoing TKA.
Bcharah et al. (Fri,) conducted a cohort in Obesity in patients undergoing primary total knee arthroplasty (n=10,905). Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) vs. Bariatric surgery or no weight-loss intervention was evaluated on Periprosthetic joint infection (PJI), aseptic loosening, periprosthetic fracture, and revision surgery at 90 days, 2 years, and 5 years (OR 1.70). Preoperative GLP-1 RA use before total knee arthroplasty was associated with lower odds of periprosthetic joint infection compared to bariatric surgery (OR 1.70 for BS vs GLP-1 RA).