Shoulder Arthroplasty Outcomes Using Glucagon-Like Peptide-1 Receptor Agonists: A Systematic Review

Background Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are increasingly prescribed for both glycemic control and weight loss, particularly in patients undergoing total joint arthroplasty. While studies on total hip and knee arthroplasty suggest potential perioperative benefits, the impact of GLP-1 RA use on outcomes following total shoulder arthroplasty (TSA) is unclear. Given the unique biomechanical demands of TSA, rising TSA volumes, and increasing GLP-1 RA use, this systematic review aims to evaluate the current literature on the impact of GLP-1 RA therapy on postoperative outcomes in TSA patients. Methods A systematic search of PubMed, Embase, and Scopus was conducted through July 26, 2025, in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies were included if they evaluated postoperative outcomes in TSA patients prescribed GLP-1 RAs. Data extracted included study design, population characteristics, matching strategy, outcomes measured, and main findings. Four retrospective case-control studies met inclusion criteria, representing a total of 7,406 TSA patients prescribed GLP-1 RAs. All studies utilized large national databases (TriNetX and PearlDiver). Results Two studies found no increase in postoperative complications among GLP-1 RA users; one demonstrated improved outcomes, including lower mortality and reduced rates of surgical site infection, pneumonia, and cardiac events, while one study reported higher rates of adverse events, including deep vein thrombosis, myocardial infarction, and readmission. Differences in findings were attributed to variation in patient populations (e.g., diabetic vs. obese), medication timing, and outcome definitions. Conclusion The current evidence on GLP-1 RA use in TSA is limited and mixed, with some studies suggesting benefit and others indicating potential risks. As the use of GLP-1 RAs becomes more widespread among TSA candidates, further prospective research is needed to clarify optimal perioperative protocols, assess patient selection, and evaluate long-term outcomes.