GLP-1 Receptor Agonists and Total Knee Arthroplasty Outcomes: A Systematic Review
Damon Ross, Lucy Fisher, Tegshjargal Baasansukh, Rolanda Willacy*, Regan Burgess, Simran Rai, Nia Dudley, Jane Boyle and Marvin Dingle
ABSTRACT
Introduction: Optimizing outcomes in total knee arthroplasty (TKA) is a priority in orthopaedics. GLP-1 receptor agonists (GLP-1 RA) help control blood sugar in diabetics and promote weight loss in obese patients. Studies show they contribute to decreased complications and improved outcomes after orthopedic surgery, but there are inconsistencies regarding its safety and efficacy. Some studies demonstrate reduced infection, readmission, and wound complications in diabetic patients, while others raise concerns about delayed healing, malnutrition, and increased complication rates among non-diabetics. This review evaluates the association between perioperative GLP-1 RA use and postoperative outcomes in TKA.
Methods: A systematic review was conducted using PRISMA 2020 guidelines. PubMed/MEDLINE, Embase, Web of Science, and Cochrane CENTRAL were searched (2015–2025). Eligible studies included adults undergoing primary TKA with reported perioperative GLP-1 RA use and postoperative outcomes.
Results: Eighteen studies met inclusion criteria. Perioperative GLP-1 RA use was associated with lower 90-day complications, fewer readmissions, and reduced prosthetic joint infection, particularly in morbidly obese and diabetic TKA patients. Studies demonstrated at 90 days and 2 years, obese GLP-1 RA users were found to have lower rates of aseptic loosening. Another study showed 45% lower odds of 1-year implant complications among GLP-1 RA users. There were varying outcomes reported in other studies demonstrating no statistically significant differences in short- or long-term PJI or revision rates between GLP-1 RA users and nonusers.
Conclusions: This systematic review shows GLP-1 RA represents a promising adjunct in optimizing obese patients prior to TKA. While encouraging, the current evidence is limited. Future research should focus on large prospective studies which stratify outcomes by surgical procedure, baseline metabolic status, and duration of GLP-1 therapy. Investigation into potential risks, including delayed wound healing or nutritional deficiencies, is necessary to ensure it is safe and effective. The use of GLP-1 RA appears to offer a meaningful opportunity to improve surgical outcomes in high-risk TKA patients.
