The Effects of Glucagon-Like Peptide-1 Agonist Therapy on Risk of Infection, Fracture, and Early Revision in Primary Total Joint Arthroplasty

📖 Top 20% JournalMay 21, 2025The Journal of the American Academy of Orthopaedic Surgeons

Glucagon-Like Peptide-1 Therapy and Its Link to Infection, Bone Fracture, and Early Surgery After First Joint Replacement

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Abstract

Periprosthetic infection rates following total knee arthroplasty (TKA) were lower in diabetic patients treated with GLP-1 agonists compared to those not treated.

Infection rates after TKA were 0.94% for the GLP-1 group versus 1.45% for the non-GLP-1 group at 3 months.
At 1 year, infection rates remained lower in the GLP-1 group (1.21%) compared to the non-GLP-1 group (2.04%).
Patients on GLP-1 agonists experienced slightly higher rates of periprosthetic fracture at both 3 months (0.47% vs. 0.21%) and 1 year (0.70% vs. 0.34%) compared to those not treated.
No significant differences in infection, revision, or periprosthetic fracture rates were found for total hip arthroplasty (THA) between GLP-1 and non-GLP-1 groups.

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INTRODUCTION: The purpose of this study was to examine rates of infection, revision, and periprosthetic fracture following total joint arthroplasty in diabetic patients treated with and without glucagon-like peptide-1 (GLP-1) agonist therapy.

METHODS: The TriNetX Global Collaborative Network was queried for patients with diabetes mellitus undergoing primary total hip arthroplasty (THA) and total knee arthroplasty (TKA) from 2005 to 2024. Patients taking GLP-1 agonists within 1 year of surgery were matched to patients without. Cohort matching was done according to race, sex, body mass index nicotine dependence, hemoglobin A1c, and estimated glomerular filtration rate A total of 9,400 TKA procedures and 4,488 THA procedures constituted evenly divided cohorts. Outcomes included infection, revision surgery, and periprosthetic fractures at 3 months and 1 year. Bonferroni correction applied with threshold P < 0.0041.

RESULTS: TKA: periprosthetic infection following TKA was lower in the GLP-1 group compared with the non-GLP-1 group at both 3 months (0.94% vs. 1.45%; P < 0.001) and 1-year (1.21% vs. 2.04%; P < 0.001). Rates of periprosthetic fracture following TKA were higher albeit not markedly in patients prescribed GLP-1 agonists versus patients not receiving GLP-1 agonists at 3-months (0.47% vs. 0.21%; P = 0.034, respectively) and at 1-year (0.70% vs. 0.34%; P = 0.015) postoperatively. THA: No notable differences were observed in rates of infection, revision, or periprosthetic fracture in patients undergoing THA between those prescribed GLP-1s versus patients not receiving GLP-1 agonists at 3-months and 1-year.

CONCLUSION: In this retrospective study of both TKA and THA among diabetic patients, we found that patients using GLP-1 agonists had a lower rate of periprosthetic infection following TKA. The benefits of GLP-1 therapy might limit infection risk, however additional research is needed to understand the effect these medications make on patient nutrition and bone metabolism.

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