Preoperative Weight Loss Before Total Joint Arthroplasty Using Novel Glucagon-Like Peptide-1 Agonists

This study determined the prevalence of glucagon-like peptide-1 (GLP-1) use before total joint arthroplasty (TJA), measured weight loss of patients on GLP-1s, and evaluated if GLP-1s were associated with outcomes.

We identified 6482 patients (2990 hips; 3492 knees) who had primary TJAs between 2019 and February 2023. The mean age was 67 years, 50% were female, and 12% had a body mass index ≥40 kg/m². Univariable and multivariable models evaluated outcomes. Mean follow-up was 3 years.

The prevalence of GLP-1s before TJA was 3%, increasing from 2% in 2019 to 5% in 2022. The mean preoperative weight change on GLP-1s was -9 pounds (range, -110 to +36 pounds). Among patients taking GLP-1s, 19% lost ≥20 pounds prior to surgery, and the mean body mass index change was -1.4 kg/m² (range, -16.3 to 6.2 kg/m²). In univariable analyses, GLP-1 use was not associated with revisions (P = .35), reoperations (P = .09), or complications (P = .23). In multivariable analyses, GLP-1s were not associated with revisions (P = .66), reoperations (P = .34), or complications (P = .85). There was no difference in the risk of a 90-day postoperative emergency department visit between those on GLP-1s vs not on those medications (odds ratio, 1.5; P = .07).

The prevalence of preoperative GLP-1s before TJA increased from 2% in 2019 to 5% in 2022, and preoperative weight change on GLP-1s varied considerably. GLP-1s were not associated with decreased postoperative risks but investigational GLP-1s before TJA require further study.

Level III.