IntroductionDiabetes and obesity are associated with increased risk of complications following total knee arthroplasty (TKA). Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have emerged as a modality for optimizing weight and glycemic control in the perioperative period. This study aims to compare 2-year postoperative complications between GLP-1 RA users and non-users, using laterality-verified methodology to ensure ipsilateral outcome attribution.MethodsA retrospective query of the TriNetX database identified patients who underwent TKA and used GLP-1 RAs within a 1-year preoperative period. GLP-1 RA patients were 1:1 propensity matched to non-user controls for demographics and confounding comorbidities. Laterality was assessed independently to ensure ipsilateral TKA and corresponding complication. Outcomes analyzed were TKA revision, periprosthetic joint infection (PJI), mechanical loosening, periprosthetic fracture, and other mechanical complications within a 2-year postoperative period. Results were further stratified to isolate outcomes among diabetic patients. Results were reported as risk ratios, 95% confidence intervals, and P values.ResultsGLP-1 RA users experienced significantly lower rates of PJI (1.5% vs. 2.0%; RR 0.74; 95% CI 0.57, 0.96; P = 0.02) compared to non-users in a 2-year postoperative period. Among diabetic patients, GLP-1 RA users had significantly lower PJI rates (1.7% vs. 2.5%; RR 0.68; 95% CI 0.52, 0.89; P < 0.01). There were no significant differences between rates of revision, mechanical loosening, periprosthetic fractures, or other mechanical complications in the overall or diabetic-only cohorts.ConclusionGLP-1 RA use was associated with a reduced risk of PJI in a 2-year postoperative period without any significant differences in mechanical outcomes in both overall and diabetic-only cohorts. This laterality-verified analysis provides more accurate outcome attribution than prior database studies and supports a selective protective effect of GLP-1 RAs against infection-related rather than mechanical complications following TKA.
