Trends in Glucagon-like peptide-1 Receptor Agonists for Weight Loss Prior to Total Joint Arthroplasty

Background Obesity is a recognized risk factor for postoperative complications in total joint arthroplasty (TJA), and interventions to reduce weight are often performed for patients planning to undergo surgery. While metabolic and bariatric surgery (MBS) is an established method for achieving preoperative weight loss in TJA candidates, the popular glucagon-like peptide-1 receptor agonists (GLP-1 RAs) may have shifted the landscape of weight loss interventions. However, this trend and its characteristics have not been described. Therefore, this study aimed to identify patient demographics and characteristics associated with GLP-1 RAs usage or MBS interventions in the TJA population. Methods The MarketScan Database was queried to identify patients with obesity who had an inpatient admission and underwent primary total hip/knee arthroplasty (THA/TKA) between January 1, 2021 and December 31, 2022. The primary exposure was the utilization of GLP-1 RAs or MBS within the year before TJA. The demographic, geographic, and time of weight loss interventions were assessed. Multivariable logistic regressions were performed, adjusting for the above covariates. Results Our study identified 31,300 patients who underwent TKA (n = 20,604) or THA (n = 10,696). Patients with obesity using GLP-1 RAs were more likely to be women (TKA odds ratio [OR] 1.50, 95% CI 1.30–1.72; THA OR 1.55, 95% CI 1.26–1.90; both P  < 0.001) and aged under 55. The usage of GLP-1 RAs increased from 2021 to 2022 (TKA OR 1.88, 95% CI 1.64–2.15; THA OR 1.57, 95% CI 1.28–1.94; both P  < 0.001), while the rates of MBS remained relatively stable over the same period. The increasing trend in GLP-1 RAs usage was observed in both diabetic and non-diabetic patients. Conclusion Our study found that patients under 55 and women were more likely to utilize MBS or GLP-1 RAs prior to TJA. We also identified an increase in GLP-1 RAs usage from 2021 to 2022, independent of diabetes status.