Przejdź do treściA meta-analysis including more than 96,000 patients suggests that people treated with GLP-1 receptor agonists before total hip or knee arthroplasty had fewer selected complications and readmissions. This should be interpreted primarily as an observational signal: all included studies were cohort studies, and certainty of evidence was rated very low for almost every outcome. The analysis therefore does not show that starting a GLP-1 receptor agonist itself reduces perioperative risk.
Why might an orthopaedic surgeon find this study interesting?
GLP-1 receptor agonists are increasingly used in people with type 2 diabetes and obesity—two groups that are common among patients undergoing joint replacement. From an orthopaedic perspective, the question is not only whether these drugs reduce body weight and improve glycaemic control, but whether their use is associated with a different risk profile after surgery.
The study by Rudran and colleagues, published on 1 August 2026 in The Bone & Joint Journal, is notable because it combines data from almost 100,000 arthroplasties. At the same time, it illustrates the difference between a large sample and strong causal evidence: the numbers are impressive, but the underlying studies remain observational.
Question and methodology
The authors performed a PRISMA-based systematic review and meta-analysis. Ten matched cohort studies were included, covering a total of 96,356 patients: 30,350 after total hip arthroplasty and 66,606 after total knee arthroplasty. Mean age was 61.9 years, and 60.1% of participants were women.
GLP-1 receptor agonists had been prescribed for type 2 diabetes or obesity. The primary outcome was 90-day surgical complications, including periprosthetic joint infection, wound dehiscence, periprosthetic fracture, haematoma, nerve injury and surgical-site infection. The authors also assessed medical complications, readmissions, revisions, length of stay and treatment costs.
Results
Across the overall cohort, GLP-1 receptor agonist use was associated with a lower rate of 90-day surgical complications, with a pooled risk ratio of 0.73. Medical complications were also lower (RR 0.78), as were hospital readmissions (RR 0.79).
The signal was stronger in the total hip arthroplasty subgroup. GLP-1 therapy was associated with lower surgical complications (RR 0.63), medical complications (RR 0.55) and readmissions (RR 0.82). After total knee arthroplasty, the only statistically significant association that remained was a lower risk of readmission (RR 0.77).
Two-year revision rates ranged from 1.7–3.3% in GLP-1 users and 1.7–4.5% in control groups. These ranges should not be interpreted as proof that GLP-1 therapy improves implant survival.
How should the findings be interpreted clinically?
The most defensible conclusion is that preoperative GLP-1 receptor agonist use was not associated with worse outcomes in the available studies, and some analyses suggested lower early complication rates. That is relevant in populations with obesity and diabetes, where metabolic optimisation is part of preparation for arthroplasty.
However, the study cannot determine how much of the observed difference comes from the pharmacological effect of the drugs, weight loss, improved glycaemic control or characteristics of the patients who receive this treatment. GLP-1 users may differ from controls in healthcare access, adherence, intensity of treatment for comorbidities and other factors that matching cannot fully remove.
Limitations
- All 10 included studies were observational; there was no randomised trial comparing initiation of GLP-1 treatment with non-use before arthroplasty.
- Two studies were judged to have a serious risk of bias and eight a moderate risk.
- GRADE certainty was very low for all analysed outcomes except costs, for which certainty was moderate.
- Indications for treatment, patient characteristics and probably the duration and type of therapy differed between studies.
- Some endpoints were composite outcomes, so a single risk ratio does not reveal which individual complication accounted for the observed difference.
- The difference between hip and knee findings may reflect a true effect, but could also reflect study heterogeneity and residual confounding.
What might this change in practice?
The study supports the view that GLP-1 receptor agonist use should not itself be treated as an automatic adverse prognostic factor before joint replacement. In a patient with obesity or diabetes, the medication may be one part of broader metabolic optimisation before surgery.
Decisions about continuing or temporarily withholding a GLP-1 receptor agonist around the time of surgery should nevertheless follow the current anaesthetic and diabetes-care protocol for the individual patient. This meta-analysis was not designed to establish perioperative medication-withholding rules.
What does the study not prove?
The analysis does not prove that GLP-1 treatment should be started solely to reduce arthroplasty complications. It also cannot establish an optimal drug, dose or treatment duration before surgery, or determine whether any potential benefit is mediated by the medication itself, weight reduction, improved glycaemia or other mechanisms. Prospective studies, ideally randomised, would be needed to answer those questions.
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Source
Rudran B, Little CDJ, Palmer AJR, Judge A, Carli A, Price AJ, Alvand A. Glucagon-like peptide-1 receptor agonists are associated with improved 90-day outcomes after total hip and knee arthroplasty: a systematic review and meta-analysis. Bone Joint J. 2026;108-B(8):986–994. DOI: 10.1302/0301-620X.108B8.BJJ-2025-1486.R2. PMID: 42538001.
Educational material for healthcare professionals. It does not constitute an individual therapeutic recommendation.
Content prepared by: Tomasz Poboży - orthopaedic surgeon.