BACKGROUND: The increasing prevalence of diabetes mellitus and obesity poses growing challenges for total joint arthroplasty, as both conditions are associated with higher risks of periprosthetic joint infection (PJI), delayed wound healing, and prolonged hospitalization. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have shown benefits in glycemic control, weight reduction, and inflammation modulation, making them a potential perioperative intervention. However, their protective effects on postoperative outcomes in arthroplasty remain uncertain, necessitating further investigation.
METHODS: A systematic literature search was conducted in PubMed, EMBASE, and Cochrane Library following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Retrospective cohort studies comparing postoperative outcomes in GLP-1 RAs users and nonusers undergoing total hip arthroplasty and total knee arthroplasty were included. Pooled odds ratios (ORs) and standardized mean differences were calculated using a random-effects model. A total of eight retrospective cohort studies involving 76,091 patients undergoing arthroplasty were included.
RESULTS: Treatment with GLP-1 RAs was associated with a significantly reduced risk of PJI at both 90 days (OR = 0.73, 95% confidence interval [CI]: 0.55 to 0.98, P = 0.038) and two years postoperatively (OR = 0.72, 95% CI: 0.60 to 0.85, P < 0.001). There were no statistically significant differences in lengths of hospital stay observed (standardized mean difference = -0.09, 95% CI: -0.20 to 0.01, P = 0.08). In addition, no associations were identified between GLP-1 RAs use and other postoperative complications, including periprosthetic fracture, aseptic loosening, revision, or wound dehiscence.
CONCLUSIONS: Among patients undergoing arthroplasty, treatment with GLP-1 RAs was associated with a reduced risk of PJI. These findings support their potential utility as adjunctive agents to improve perioperative outcomes and warrant confirmation through prospective clinical trials.
