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GLP-1 agonists are protective against postoperative complications following total knee arthroplasty

Rachel Ranson¹, Philip M Parel¹, Julia Kirkland²

¹Department of Orthopaedic Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC, United States.

|August 20, 2025

Abstract

Background:

Glucagon-like peptide-1 receptor agonists (GLP1RAs) have gained prominence for managing type 2 diabetes mellitus and obesity. Their impact in orthopedic surgery, particularly total knee arthroplasty (TKA), remains underexplored. Thus, this study aimed to investigate the influence of GLP1RAs on 90-day medical complications and 2-year surgical outcomes following TKA.

Methods:

A retrospective cohort analysis was performed using a national all-payer claims database. Patients who underwent primary TKA were stratified into two groups: patients who received a GLP1RA within 6 months prior to surgery (GLP-1 cohort) and patients who did not have a GLP1RA history. Outcomes included the incidence of 90-day readmission and medical complications, and 2-year surgical complications. Univariate and multivariable regression analysis was conducted to compare outcomes.

Results:

Patients in the GLP-1 cohort exhibited a lower 90-day readmission rate (OR: 0.77; P < 0.001) and fewer medical complications such as arrhythmia (OR: 0.78), death (OR: 0.24), and deep vein thrombosis (OR: 0.70) compared to the control (P < 0.05 for all). However, they experienced a higher odds of acute renal failure (OR: 1.16; P = 0.001). No significant differences were observed in 2-year surgical outcomes.

Conclusion:

GLP1RAs use is associated with a reduced incidence of certain 90-day medical complications following TKA. We believe that this is likely due to their effects on weight loss and glycemic control. However, they are associated with an increased risk of acute renal failure. GLP1RAs do not appear to influence long-term surgical outcomes, suggesting their benefits are primarily confined to the early postoperative period.

Keywords:

Complications GLP-1 Glucagon-like peptide-1 agonist Revision Total knee arthroplasty

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