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

Why It Matters

If validated, GLP‑1 RAs could become a pharmacologic tool for pre‑operative weight‑loss optimization, potentially lowering costly revision surgeries and transfusions in the expanding joint‑replacement market.

Key Takeaways

• GLP‑1 RA users had 20% lower revision risk at 90 days.
• Blood transfusion odds dropped 45% for patients on GLP‑1 RAs.
• No significant change in respiratory, AKI, DVT, or infection rates.
• Evidence quality low; larger RCTs needed to confirm benefits.

Pulse Analysis

Obesity remains a leading modifiable risk factor for complications after total hip and knee arthroplasty, prompting surgeons to seek effective pre‑operative weight‑loss strategies. Traditional approaches—dietary counseling, bariatric surgery, or intensive lifestyle programs—often face adherence challenges and delayed timelines. In recent years, glucagon‑like‑peptide‑1 receptor agonists, originally approved for type‑2 diabetes, have gained attention for their robust appetite‑suppressing effects and modest weight reduction, positioning them as a non‑invasive adjunct for surgical candidates seeking rapid optimization.

The meta‑analysis of six retrospective cohorts, encompassing more than 48,000 procedures, reveals that patients prescribed GLP‑1 RAs experienced a 20 % lower odds of revision surgery and a 45 % reduction in blood‑transfusion requirements within the first 90 days. These findings suggest that even modest pre‑operative weight loss mediated by GLP‑1 RAs can translate into tangible peri‑operative benefits, likely through improved hemoglobin levels and reduced surgical stress. However, the analysis showed no statistically significant impact on respiratory complications, acute kidney injury, deep‑vein thrombosis, or infection, underscoring that the drug’s advantage may be confined to specific outcomes rather than a broad safety net.

Despite the promising signals, the evidence base is limited by moderate risk‑of‑bias assessments and low GRADE certainty, reflecting the retrospective nature of the data. Prospective, adequately powered randomized controlled trials are essential to confirm causality, define optimal dosing windows, and assess cost‑effectiveness relative to traditional weight‑loss interventions. Should future research validate these early results, orthopedic pathways could integrate GLP‑1 RA therapy into pre‑operative optimization protocols, offering a scalable, pharmacologic option that aligns with the growing demand for joint replacement procedures in an aging, increasingly obese population.