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

Background : Obesity is a modifiable risk factor for poorer outcomes in hip and knee arthroplasty patients. Weight loss prior to hip or knee arthroplasty has been shown to reduce postoperative complications. Glucagon-like-peptide-1 receptor agonists (GLP-1 RAs) are emerging non-invasive alternatives for weight loss. We aimed to understand the effects of these medications on perioperative outcomes and to explore their role in preoperative optimisation strategies. Methods : Studies that compared adults who underwent primary hip or knee arthroplasty with and without GLP-1 RA use were included. Non-randomised (cohort and case‒control) and randomised controlled trials were included. The following electronic databases were searched using the indexed terms for ‘orthopaedic surgery’ and ‘GLP-1 RA’ from inception to 1/10/25, with no language or publication date restrictions: the Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, Scopus, Embase via Ovid, ProQuest, PubMed and MEDLINE. Data extraction was conducted via the Covidence Systematic Review tool. The risk of bias for non-randomised studies was assessed via the ROBINS-I V2 tool. Publication bias across studies was evaluated via funnel plot symmetry. The GRADE classification was used to assess the certainty of evidence. We conducted a meta-analysis via Review Manager (RevMan) version 5.3. Two reviewers worked independently throughout the process, and a third reviewer was used to resolve any discrepancies. Results : We included a total of 6 retrospective cohort database studies involving over 48,000 hip or knee arthroplasty patients. There was a significantly reduced risk of revision (OR = 0.8 95% CI: 0.66–0.98; P = 0.03) and transfusion (OR = 0.55 95% CI: 0.41–0.73; P ≤ 0.0001) in the GLP-1 RA group for total hip or knee arthroplasty at 90 days post-surgery. There was no statistically significant difference between the groups in terms of the risk for respiratory complications (OR = 0.79 95% CI: 0.61–1.01; P = 0.06), acute kidney injury (AKI) (OR = 0.98 95% CI: 0.89–1.09; P = 0.76), aseptic loosening (OR = 0.72 95% CI: 0.44–1.18; P = 0.19), deep venous thrombosis (DVT) (OR = 0.89 95% CI: 0.77–1.03; P = 0.12), emergency department (ED) visits (OR = 0.93 95% CI: 0.83–1.03; P = 0.16), hematoma (OR = 0.63 95% CI: 0.29–1.37; P = 0.25), or periprosthetic fracture (OR = 1.08 95% CI: 0.74–1.58; P = 0.68) or sepsis (OR = 1.03 95% CI: 0.49–2.05; P = 0.83) at 90 days following total hip or knee arthroplasty. The overall risk of bias assessment via the ROBINS-I-V2 tool was moderate. The certainty of evidence for these findings was low according to the GRADE classification. Conclusion : In summary, we found that GLP-1 RAs are safe to use prior to hip and knee arthroplasty surgery and may play a role in preoperative optimisation to help improve postoperative outcomes. Prospective studies, including large randomised controlled trials, are needed to validate these correlations.