Obesity and diabetes are common among patients undergoing total hip arthroplasty (THA) and are associated with adverse outcomes. Glucagon-like peptide 1 receptor agonists (GLP-1 RAs) were originally developed for glycaemic control but have recently been approved for weight reduction. Given these dual metabolic effects, their perioperative use is of growing interest. Despite this, the impact of GLP-1 RAs on post-operative outcomes remains underexplored. This systematic review and meta-analysis aim to address this evidence gap. A literature search was conducted in MEDLINE, PubMed, Embase, and CENTRAL from inception to 1st June 2025. Studies comparing outcomes between GLP-1 RA users and non-users in adults (≥18 years) undergoing primary THA were included. Primary outcomes included medical and surgical complications. Secondary outcomes included hospital-related measures such as 90-day readmissions and length of stay. Risk of bias was assessed using the Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I) tool, and the certainty of evidence was evaluated using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. Six retrospective cohort studies, all conducted in the United States, met the inclusion criteria and included 11,869 GLP-1 RA users and 22,777 controls. GLP-1 RAs use was associated with a statistically significant reduction in 90-day readmission rates (odds ratio (OR) 0.81, 95% confidence interval (CI) 0.69-0.94, p = 0.007; I= 39%) and short-term revision surgery (OR 0.70, 95% CI 0.52-0.94, p = 0.02; I= 18%). No significant differences were observed for other medical or surgical complications. GLP-1 RAs were associated with reduced short-term revision rates and 90-day readmissions following THA. However, as only retrospective studies were identified, high-quality prospective studies are needed to confirm these findings. 2 2
