Impact of Glucagon-Like Peptide-1 Receptor Agonists on Postoperative Outcomes in Arthroplasty: A Systematic Review

The use of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) has expanded due to their effectiveness in weight management, with increasing applications beyond diabetes care. Given the strong association between obesity and suboptimal total joint arthroplasty outcomes, evaluating how GLP-1 RAs affect postoperative outcomes is essential. However, few studies have synthesized available evidence.

A systematic review was conducted following the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Embase, and Scopus were searched for studies published until January 29, 2025, using terms related to GLP-1 RAs and arthroplasty. Studies analyzing postoperative outcomes in patients undergoing total knee arthroplasty or total hip arthroplasty while taking GLP-1 RAs were included. Articles were screened, and data on study characteristics and key findings were extracted. There were seven studies, totaling 16,467 patients undergoing arthroplasty who were taking GLP-1 RAs, which met inclusion criteria, with six utilizing national databases and one based on institutional data. There were three that focused on diabetic GLP-1 users; four included both diabetic and nondiabetic GLP-1 RA users.

Among the included studies, GLP-1 RA use was most commonly associated with reduced postoperative complications, including lower rates of periprosthetic joint infection, readmissions, and wound complications following total knee arthroplasty or total hip arthroplasty. Some studies reported no differences in outcomes or increased rates of adverse events such as myocardial infarction, hypoglycemia, or postoperative nausea. Overall, five studies reported primarily beneficial effects, while one showed mixed results and one reported predominantly negative findings.

Current evidence suggests GLP-1 RAs may improve total joint arthroplasty outcomes, particularly by reducing infection risk and readmission. However, conflicting findings highlight the need for further research, particularly well-designed multicenter studies and randomized controlled trials, to clarify the effects of GLP-1 RAs on surgical outcomes.