Impact of glucagon-like peptide-1 receptor agonists on postoperative complications after total joint arthroplasty: A systematic review and meta-analysis

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Background Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are increasingly prescribed for obesity and type 2 diabetes mellitus (T2DM). While their metabolic benefits are well-established, their impact on postoperative outcomes following total joint arthroplasty (TJA) remains controversial. This study aimed to systematically evaluate the association between GLP-1 RA use and postoperative outcomes in patients undergoing total hip (THA), knee (TKA), or shoulder arthroplasty (TSA). Methods We conducted a PRISMA-compliant systematic review and meta-analysis across PubMed, Embase, Web of Science, and Scopus through April 24, 2025. Eligible retrospective cohort studies compared adults undergoing TJA with and without preoperative GLP-1 RA exposure. Primary outcomes were 90-day readmission and all-cause revision. Pooled odds ratios (ORs) and standardized mean differences (SMDs) were calculated under random-effects models. Subgroup analysis based on the type of arthroplasty was conducted where applicable. Results Fourteen studies (total sample size of 365,154; including 62,117 (17.01%) GLP-1 consumers, and 303,037 (82.98%) control cases) met the inclusion criteria (All studies included primary TJA cases). GLP-1 RA use was associated with lower 90-day readmission (OR = 0.86, 95% CI: 0.74-0.99, p = 0.033) and reduced sepsis incidence (OR = 0.63, 95% CI: 0.46–0.88, p = 0.006). No significant differences were observed for all-cause revision, thromboembolic events, and other medical and surgical complications. Length of stay was marginally shorter in GLP-1 users (SMD = −0.09, p = 0.048). Subgroup analyses showed the strongest sepsis reduction in TSA. Conclusion GLP-1 RA use before TJA is associated with reduced readmission and sepsis risk without increasing surgical or thromboembolic complications. These findings support the potential perioperative benefits of GLP-1 RAs, warranting prospective trials to confirm causality and define optimal perioperative strategies for high-risk arthroplasty patients.