Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are increasingly used for weight loss and may therefore have a role in preoperative optimisation for arthroplasty candidates. However, their effect on arthroplasty outcomes remains unclear. This systematic review aims to evaluate existing evidence on preoperative GLP-1 RA use and postoperative outcomes following joint arthroplasty, and to identify priorities for future research and perioperative optimisation. A systematic literature search of PubMed, Embase, ClinicalTrials.gov and the Cochrane Library was conducted for articles published from inception to 29th July 2025, using terms related to GLP-1 RAs and arthroplasty, in accordance with the PRISMA 2020 guidelines. Studies were included if they assessed postoperative outcomes in adult patients undergoing arthroplasty with documented preoperative GLP-1 RA use. Data were extracted on study design, participant characteristics, GLP-1 RA use, arthroplasty procedure, outcome measures, duration of follow-up, and key results. Fifteen retrospective studies met the inclusion criteria, comprising a total of 39,355 patients undergoing hip, knee or shoulder arthroplasty. Nine studies reported more favourable postoperative outcomes among GLP-1 RA users, three showed mixed results, two predominantly reported worse outcomes, and one found no significant difference. The most frequently reported favourable associations were lower periprosthetic joint infection and hospital readmission rates following hip and knee arthroplasty, particularly among individuals with diabetes or morbid obesity, although results were not uniform across studies. In contrast, evidence relating to shoulder arthroplasty outcomes was limited and showed greater variability. Preoperative GLP-1 RA use has been associated with lower rates of periprosthetic joint infection and readmission in several retrospective database studies, particularly in diabetic and morbidly obese arthroplasty populations; however, the overall certainty of evidence is low due to non-randomised designs, heterogeneity and risk of bias. These findings should be considered hypothesis-generating, and well-designed prospective studies and randomised controlled trials are required to establish the role of GLP-1 RAs in preoperative optimisation.
