Obesity is a well-established risk factor for perioperative morbidity, including periprosthetic joint infection (PJI) and unplanned readmission following total hip and knee arthroplasty. Glucagon-like peptide-1 (GLP-1) receptor agonists induce clinically meaningful weight loss and metabolic optimisation, yet their perioperative influence in arthroplasty populations remains uncertain. In this systematic review and meta-analysis of observational cohorts comprising adults with obesity undergoing primary hip or knee arthroplasty, outcomes were compared between patients receiving perioperative GLP-1 therapy and those not exposed to these agents. Eight cohorts encompassing 95,503 individuals, including 22,098 GLP-1 users, met inclusion criteria. Perioperative GLP-1 therapy was associated with a significantly reduced incidence of PJI after total hip arthroplasty and fewer 90-day hospital readmissions, corresponding to an absolute risk reduction of approximately 1.8% from a median baseline risk of 9% and an estimated number needed to treat of 56. No significant association was demonstrated for PJI following total knee arthroplasty or for revision procedures, and GLP-1 therapy was not linked to increased rates of venous thromboembolism, acute kidney injury, cerebrovascular events, myocardial infarction, or hypoglycaemia. Certainty of evidence was moderate for hip PJI and readmission and low for knee PJI and revision outcomes. These findings suggest that perioperative GLP-1 therapy may confer clinically relevant benefits in selected arthroplasty populations, underscoring the need for well-designed randomised trials to define optimal perioperative protocols, economic value, and long-term implant survivorship.
