Glucagon-Like Peptide-1 Receptor Agonists in Hip and Knee Arthroplasty: A Comprehensive Systematic Review and Meta-Analysis of Perioperative and Postoperative Outcomes

Q: What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: Total hip and knee arthroplasty (THA and TKA) (n=1408609). Intervention: Glucagon-like peptide-1 receptor agonists (GLP-1RAs) vs. Non-GLP-1RA users. Primary outcome: 90-day periprosthetic joint infection (PJI) (OR 0.77, 95% CI 0.66-0.89).

Q: What does this research mean for the field?

Perioperative GLP-1RA use in total hip and knee arthroplasty is associated with reduced 90-day periprosthetic joint infection, all-cause revision, and readmission without increasing short-term medical or aspiration risks. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

Benjamin Wajda; Darren Van Essen; Sabrina Martini; Golpira Elmi Assadzadeh; Rajrishi Sharma; Jason Werle

doi:10.1016/j.artd.2026.102043

May 16, 2026Arthroplasty TodayOpen Access

Glucagon-Like Peptide-1 Receptor Agonists in Hip and Knee Arthroplasty: A Comprehensive Systematic Review and Meta-Analysis of Perioperative and Postoperative Outcomes

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Key result

Perioperative GLP-1RA exposure linked to ~23% lower risk of 90-day periprosthetic joint infection in arthroplasty.

OR 0.77
95% CI 0.66-0.89
n=1,408,609

Figures

Why the study?

GLP-1 receptor agonists are increasingly used for metabolic optimization, but their perioperative safety and effect on hip and knee arthroplasty outcomes remain unclear.

Does perioperative GLP-1RA use improve postoperative outcomes and reduce complication risks in adults undergoing THA and TKA?

Key Points

To evaluate the associations between perioperative glucagon-like peptide-1 receptor agonist (GLP-1RA) use and postoperative surgical and medical outcomes following total hip arthroplasty (THA) and total knee arthroplasty (TKA).
PRISMA-compliant systematic review and meta-analysis searching PubMed, MEDLINE, and EMBASE through August 20, 2025.
Included 13 retrospective cohort studies covering 1,408,609 adult patients (39,614 THA and 1,373,771 TKA) receiving GLP-1RAs within 0–12 months preoperatively or ≤30 days postoperatively.
Fixed- and random-effects models were applied to evaluate surgical complications, medical complications, and resource utilization at 90 days, 1 year, and 2 years.
Perioperative GLP-1RA therapy was associated with decreased 90-day periprosthetic joint infection (OR: 0.77; 95% CI: 0.66–0.89), 90-day all-cause revision (OR: 0.88; 95% CI: 0.82–0.95), and 90-day readmission (OR: 0.79; 95% CI: 0.70–0.89).
No significant associations were observed for superficial surgical site infection (OR: 0.83; 95% CI: 0.63–1.10), deep vein thrombosis (OR: 0.91; 95% CI: 0.71–1.16), pulmonary embolism (OR: 0.94; 95% CI: 0.68–1.30), or overall hospital length of stay (MD: –0.3 days; 95% CI: –0.7 to 0.0).

Study Design

Type

Meta-Analysis (n=1,408,609)

Structured PICO

Does perioperative GLP-1RA use improve postoperative outcomes and reduce complication risks in adults undergoing THA and TKA?

P

Population

1,408,609 adults undergoing elective primary or revision total hip or knee arthroplasty with perioperative GLP-1RA exposure, assessed for short- and long-term postoperative outcomes.

E

Exposure

Perioperative GLP-1RA exposure (e.g., semaglutide, liraglutide, exenatide, or dulaglutide) for weight-loss, diabetes, or both, occurring 0-12 months preoperatively or ≤30 days postoperatively.

C

Comparator

No GLP-1RA use prior to or during the perioperative period.

O

Outcome

Postoperative clinical and surgical outcomes at 90 days, 1 year, and 2 years, primarily focusing on 90-day periprosthetic joint infection, 90-day all-cause revision, and 90-day readmission.safety

Main Result

Odds Ratio: 0.77 (95% CI 0.66–0.89)

Perioperative GLP-1RA use in THA and TKA is associated with lower early risks of infection, revision, and readmission without increasing short-term medical complications, though an increased risk of fracture at 1 year necessitates further study.

Limitations

All included studies were retrospective cohorts, subject to selection bias, unmeasured confounding, and methodological heterogeneity.
Several studies used overlapping administrative databases, raising the possibility of duplicate patients.
Lack of granular clinical data precluded assessment of perioperative glycemic control, weight change, or thresholds of weight loss.
Heterogeneity in the indication for GLP-1RA use (inability to distinguish indication at the patient level).
Socioeconomic factors and access to care differences were not captured.
All included studies were retrospective cohorts, subject to selection bias and unmeasured confounding.
Overlapping administrative databases raise the possibility of duplicate patients.
Outcomes dependent on coding accuracy.
Heterogeneity in the indication for GLP-1RA use (inability to distinguish if patients were treated for diabetes versus weight loss).

Ask about this paper

Answers are grounded in this paper and cite their sources.

Implication

May support perioperative GLP-1RA consideration in THA/TKA to lower early complications; leaves open randomized confirmation and fracture risk assessment.

Abstract

Background: Obesity drives demand for total hip arthroplasty (THA) and total knee arthroplasty (TKA) and increases the risks of infection, wound complications, and revision. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are increasingly used for metabolic optimization, but their perioperative safety and effect on arthroplasty outcomes remain unclear. This study evaluated associations between perioperative GLP-1RA use and postoperative outcomes following THA and TKA. Methods: A Preferred Reporting Items for Systematic Reviews and Meta-Analyses-compliant systematic review identified studies of adults undergoing primary or revision THA/TKA with perioperative GLP-1RA exposure (0-12 months preoperatively or ≤30 days postoperatively). PubMed, MEDLINE, and EMBASE were searched through August 20, 2025. Data on demographics, surgical and medical complications, and resource use were collected at 90 days and 1-2 years. Fixed- and random-effects meta-analyses pooled odds ratios (ORs) with 95% confidence intervals (CIs). Results: Thirteen retrospective cohorts including 1,408,609 patients (39,614 THA; 1,373,771 TKA) were analyzed. GLP-1RA use was associated with reduced 90-day periprosthetic joint infection (OR: 0.77; 95% CI: 0.66-0.89), lower 90-day all-cause revision (OR: 0.88; 95% CI: 0.82-0.95), and decreased 90-day readmission (OR: 0.79; 95% CI: 0.70-0.89). A 1-year increase in periprosthetic fracture risk was observed (OR: 1.49; 95% CI: 1.08-2.07), mainly in TKA. No associations were seen for venous thromboembolism, pulmonary embolism, renal failure, pneumonia, cardiac arrest, or aspiration. Conclusions: Perioperative GLP-1RA use in THA and TKA improves early infection, revision, and readmission outcomes without increasing short-term medical or aspiration risk. The observed 1-year fracture risk warrants further study. Prospective trials are needed to define optimal timing and patient selection.

Discussion

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Cite This Study

Wajda et al. (2026) conducted a meta-analysis in Total hip and knee arthroplasty (THA and TKA) (n=1,408,609). Glucagon-like peptide-1 receptor agonists (GLP-1RAs) vs. Non-GLP-1RA users was evaluated on 90-day periprosthetic joint infection (PJI) (OR 0.77, 95% CI 0.66-0.89). Perioperative GLP-1RA exposure in patients undergoing hip and knee arthroplasty was associated with reduced 90-day periprosthetic joint infection, all-cause revision, and readmission.

synapsesocial.com/papers/6a98da88a365341034361c94 https://doi.org/10.1016/j.artd.2026.102043

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Glucagon-Like Peptide-1 Receptor Agonists in Hip and Knee Arthroplasty: A Comprehensive Systematic Review and Meta-Analysis of Perioperative and Postoperative Outcomes

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Glucagon-Like Peptide-1 Receptor Agonists in Hip and Knee Arthroplasty: A Comprehensive Systematic Review and Meta-Analysis of Perioperative and Postoperative Outcomes

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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