Trends in Glucagon-like peptide-1 Receptor Agonists for Weight Loss Prior to Total Joint Arthroplasty

Trends in Glucagon-like peptide-1 Receptor Agonists for Weight Loss Prior to Total Joint Arthroplasty | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Trends in Glucagon-like peptide-1 Receptor Agonists for Weight Loss Prior to Total Joint Arthroplasty Katharine Playter, Yuan-Hsin Chen, Andrew Grant, Ya-Wen Chen, and 7 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7490872/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract Background Obesity is a recognized risk factor for postoperative complications in total joint arthroplasty (TJA), and interventions to reduce weight are often performed for patients planning to undergo surgery. While metabolic and bariatric surgery (MBS) is an established method for achieving preoperative weight loss in TJA candidates, the popular glucagon-like peptide-1 receptor agonists (GLP-1 RAs) may have shifted the landscape of weight loss interventions. However, this trend and its characteristics have not been described. Therefore, this study aimed to identify patient demographics and characteristics associated with GLP-1 RAs usage or MBS interventions in the TJA population. Methods The MarketScan Database was queried to identify patients with obesity who had an inpatient admission and underwent primary total hip/knee arthroplasty (THA/TKA) between January 1, 2021 and December 31, 2022. The primary exposure was the utilization of GLP-1 RAs or MBS within the year before TJA. The demographic, geographic, and time of weight loss interventions were assessed. Multivariable logistic regressions were performed, adjusting for the above covariates. Results Our study identified 31,300 patients who underwent TKA (n = 20,604) or THA (n = 10,696). Patients with obesity using GLP-1 RAs were more likely to be women (TKA odds ratio [OR] 1.50, 95% CI 1.30–1.72; THA OR 1.55, 95% CI 1.26–1.90; both P < 0.001) and aged under 55. The usage of GLP-1 RAs increased from 2021 to 2022 (TKA OR 1.88, 95% CI 1.64–2.15; THA OR 1.57, 95% CI 1.28–1.94; both P < 0.001), while the rates of MBS remained relatively stable over the same period. The increasing trend in GLP-1 RAs usage was observed in both diabetic and non-diabetic patients. Conclusion Our study found that patients under 55 and women were more likely to utilize MBS or GLP-1 RAs prior to TJA. We also identified an increase in GLP-1 RAs usage from 2021 to 2022, independent of diabetes status. Health sciences/Health care/Therapeutics/Surgery/Bariatric surgery Health sciences/Health care/Weight management Health sciences/Risk factors Figures Figure 1 Figure 2 Figure 3 Figure 4 INTRODUCTION Obesity is a prevalent and considerable challenge in total joint arthroplasty (TJA) due to the increased risk of complications. 1 , 2 Preoperative optimization of this comorbidity is crucial, and the American Association of Hip and Knee Surgeons recommends a body mass index (BMI) cutoff of 40 for safe TJA. 3 , 4 Many patients with obesity often have arthritis necessitating surgery and, therefore, utilize weight loss strategies to become eligible for TJA. 5 , 6 Metabolic and bariatric surgery (MBS) is an established method for achieving preoperative weight loss in TJA candidates. However, the indications for MBS limit patient eligibility, and concerns about surgical risks deter patients with comorbidities. 7 Recently, non-surgical interventions have been shown to be effective in reducing BMI before surgery. 8 , 9 Glucagon-like peptide 1 receptor agonists (GLP-1 RAs) are established treatments for glycemic control in diabetes and have been increasingly utilized for weight loss following Food and Drug Administration approval. 6 , 10 Multiple studies have explored the impact of GLP-1 RAs in orthopaedics, with some indicating a beneficial effect on bone mineral density and fracture risk. 11 – 14 Additionally, recent research has discussed their potential role in preoperative weight loss for TJA. 6 , 15 , 16 However, the extent of their usage and implications in TJA have not yet been comprehensively demonstrated. 15 , 17 , 18 The rapid increase in GLP-1 RAs utilization warrants further investigation. Although studies have found that GLP-1 RAs may be disease-modifying therapies for knee osteoarthritis by mediating weight loss as well as inflammatory pathways, their perioperative impacts remain uncertain, 19 – 22 with some studies reporting risks of kidney injury, myocardial infarction, and pneumonia, while others have found no significant risks. 23 – 25 There is limited data on whether there has been a significant change in the strategies used for weight loss in the TJA population. Therefore, we aim to identify patient demographics and characteristics associated with GLP-1 RAs usage or MBS interventions in the TJA population. METHODS Data Source The MarketScan Database includes over 273 million unique patients annually, comprising insured employees, retirees, their spouses, and dependents under employer-sponsored private health insurance in the United States. 26 The databases enable longitudinal tracking of patients across different institutions and providers. The Commercial Claims and Encounters database contains medical and pharmaceutical data sourced from employers and health plans. This study was approved by the New England Baptist Hospital Institutional Review Board. Cohort Selection We conducted a retrospective study that included patients with obesity who had an inpatient admission and underwent total hip arthroplasty (THA; Current Procedural Terminology [CPT] 27130) or total knee arthroplasty (TKA; CPT 27447) between January 1, 2021 and December 31, 2022. Obesity was identified via the International Classification of Diseases, 10th Revision (ICD-10) codes (Supplement Table 1 ). Patients without continuous enrollment during the study period and patients who used non-GLP-1 RAs weight loss drugs within 1 year prior to TJA were excluded. These weight loss drugs were Bupropion-naltrexone (Contrave/Mysimba), Orlistat (Xenical, Alli), Phentermine-topiramate (Qsymia), and Setmelanotide (Imcivree). 27 Defining Weight Loss Interventions and Covariates Patients were identified to have utilized GLP-1 RAs or undergone MBS within a year leading up to TJA. GLP-1 RAs included liraglutide, semaglutide, and tripeptide. Covariates were patient demographics, comorbidities, and year of TJA. Patient demographics included age, sex, and geographic region (Northeast, Midwest, South, or West). Patient comorbidities were diabetes, hypertension, hypercholesterolemia, and cancer, identified with ICD-10 codes. Data Analyses The demographic, geographic, and temporal characteristics of GLP-1 RAs and MBS utilization were assessed using Chi -squared analyses. Multivariate logistic regressions were performed, adjusting for patient demographics, comorbidities, and year of TJA using STATA (Version.17.0; StataCorp). Additionally, we conducted a sensitivity analysis to test whether a subgroup of TJA patients with obesity and without diabetes exhibited similar trends. This analysis was performed because GLP-1 RAs are commonly prescribed for diabetic patients. By focusing on non-diabetic patients, we can evaluate the use of GLP-1 RAs for weight loss beyond diabetes management. A P -value cutoff of < 0.05 was used for statistical significance. All effect estimates were reported with corresponding 95% confidence intervals (CIs). Baseline Population Demographics A total of 31,300 patients were included in the study, with a median age of 61 years (Interquartile range, 56 to 66) and 17,734 (56.7%) women. There were 20,604 (65.8%) patients who underwent TKA, and 10,696 (34.2%) patients who underwent THA. RESULTS Patient Characteristics with GLP-1 RAs and MBS Usage among TKA Patients Table 1 A shows that patients who received GLP-1 RAs before TKA (n = 1,033) were significantly younger average age and were more likely to be women. These patients were also more likely to be diagnosed with higher BMI, diabetes, hypertension, hypercholesterolemia, and cancer compared to patients who did not receive GLP-1 RAs. Additionally, patients who received MBS before TKA (n = 170) exhibited similar characteristics but did not demonstrate higher likelihood of hypercholesterolemia and cancer. Figure 1 A illustrates the trend of GLP-1 RAs and MBS usage among TKA patients from 2021 to 2022. There was a significant increase in the use of GLP-1 RAs among TKA patients in 2022 compared to 2021, while the usage of MBS remained relatively stable over this period. In the adjusted analysis (Fig. 2 A), patients using GLP-1 RAs before TKA were more likely to be women (odds ratio [OR] 1.50, 95% CI 1.30–1.72, P < 0.001) or aged under 55. Specifically, the likelihood of using GLP-1 RAs decreased with age (OR for ages 55–59, 60–64, and ≥ 65 were 0.78, 0.69, and 0.21, respectively; all P ≤ 0.01). Moreover, there was a significant increase in GLP-1 RAs usage in 2022 compared to 2021 (OR 1.88, 95% CI 1.64–2.15, P < 0.001). On sensitivity analysis focusing on TKA patients with obesity and without diabetes TKA patients, the results were consistent with the overall findings. Among non-diabetic patients, the usage of GLP-1 RAs also increased from 2021 to 2022. Patient Characteristics with GLP-1 RAs and MBS Usage among THA Patients The results among THA patients are qualitatively similar. As shown in Table 1 B, patients who received GLP-1 RAs before THA (n = 417) were significantly younger and more likely to be women. These patients were also more likely to be diagnosed with higher BMI, diabetes, hypertension, and hypercholesterolemia compared to those who did not receive GLP-1 RAs. For patients who received MBS before THA (n = 81), similar characteristics were observed, except for the absence of diabetes and hypercholesterolemia. The trend in the use of GLP-1 RAs and MBS among THA patients from 2021 to 2022 is depicted in Fig. 1 B. There was a marked increase in the use of GLP-1 RAs among THA patients in 2022 compared to 2021, while the usage of MBS remained relatively stable during this period. Adjusted analysis (Fig. 2 B) revealed that patients using GLP-1 RAs before THA were more likely to be women (OR 1.55, 95% CI 1.26–1.90, P < 0.001) and less likely to age 60 or older. Furthermore, there was a significant increase in GLP-1 RAs usage in 2022 compared to 2021 (OR 1.57, 95% CI 1.28–1.94, P < 0.001). In the sensitivity analysis focusing on THA patients with obesity and without diabetes, we observed similar results. The usage of GLP-1 RAs among non-diabetic patients increased from 2021 to 2022. DISCUSSION Given the rapid increase in the utilization of GLP-1 RAs in the United States and theoretical implications for its usage in the TJA patients, we sought to better characterize the trends of GLP-1 RAs usage in this population. Our study found that patients with obesity using GLP-1 RAs prior to TKA or THA were more likely to be women or aged under 55. Also, among patients who underwent TKA or THA, the usage of GLP-1 RAs increased from 2021 to 2022, while the rates of MBS remained relatively stable over the same period. The increasing trend of GLP-1 RAs usage was observed in both diabetic and non-diabetic patients. The literature on the demographic characteristics of GLP-1 RAs usage in TJA is limited. Most previous studies did not focus on surgical patients. Among the general population, GLP-1 RAs users are more likely to be women and younger compared to non-users. 28 – 30 According to a report done by Blue Cross Blue Shield Association, the majority of GLP-1 RAs users were women and between ages of 35 and 54. 28 Besides, a recent study similarly indicated that new GLP-1 RAs users were disproportionately women. 29 To the best of our knowledge, our analysis of the demographic trends of GLP-1 RAs use in TJA is novel, revealing that GLP-1 RAs users were more likely to be under 55 or women. This finding aligns with the higher morbidity rates associated with elderly patients, making it reasonable that GLP-1 RAs users tend to be younger. 31 However, the association between women and higher GLP-1 RAs use remains unclear. It is possible that women often seek medical care more regularly and are more proactive in weight management, which may account for the higher prevalence of GLP-1 RAs use among them. 32 A recent report by the American Academy of Orthopaedic Surgeons demonstrated an increasing trend in the use of GLP-1 RAs before TJA from 2019 to 2023 among patients with a BMI between 35 and 45. 33 Additionally, an evidence shows that more new prescriptions for GLP-1 RAs have been written in recent years, with the proportion of new users with a BMI of 30 or higher rising from 47% to over 66% from 2011 to 2023. 29 Our study expands the current understanding by demonstrating that patients with obesity increased their usage of GLP-1 RAs before TJA, and this trend was observed among both diabetic and non-diabetic patients. This suggests that GLP-1 RAs represent a strong option for patients needing to lose weight prior to TJA. A recent editorial even suggested that GLP-1 RAs could increase the number of eligible patients for elective TJA. 18 On the other hand, our study showed that the volume of MBS remained relatively stable from 2021 to 2022. This seems to conflict with the understanding that the rising popularity of GLP-1 RAs might reduce the demand for MBS. 34 It is unclear why MBS didn’t decrease in the present study. The possible reason for this may be that GLP-1 RAs and MBS are not at odds, due to the effectiveness and durability of weight loss. A systematic review found that MBS produces greater and more durable weight loss than GLP-1 RAs, while the effects of GLP-1 RAs are durable only with sustained use of the medications. 35 Furthermore, sustained weight loss from MBS is associated with a lower risk of comorbidities. Therefore, both GLP-1 RAs and MBS have a place in providing treatment options for patients needing to lose weight. Our study has several strengths. It utilized a nationwide commercial claims database, allowing for a representative exploration of trends in the use of GLP-1 RAs and MBS. This database also enabled longitudinal tracking of patients across various providers and facilities, enhancing the generalizability of our findings. However, there are limitations to our study. We did not include most patients with Medicare, as our analysis utilized a commercial claims database. Despite this exclusion, the elderly represent a relatively small proportion of those undergoing weight loss interventions, so our results remain valid even without their inclusion. CONCLUSION Our study found that patients who aged under 55 and women were more likely to utilize MBS or GLP-1 RAs. We also identified a significant increase in the proportion of TJA patients utilizing GLP-1 RAs from 2021 to 2022 that seemed to be independent of diabetes status. We anticipate that the findings of this study will increase physician awareness of the strategies being utilized in their patient population, and aid them and their patients in choosing a weight loss intervention when necessary prior to TJA. Declarations Conflict of Interest Statement: Katharine Playter owns stock in Intuitive Surgical & Medtronic Carl T. Talmo is an employee of Astra-Zeneca, receives IP royalties for DJ Orthopaedics, and is a paid consultant for Zimmer and DJ Orthopaedics Eric L. Smith Receives IP royalties from DePuy Synthes, has other professional activities with DePuy Synthes and ConforMIS, Inc, and is on the board of directors or is a committee member of AAOS, AAHKS, and The Knee Society Yuan-Hsin Chen, Andrew Grant, Ya-Wen Chen, Hannah I. Travers, Ruijia Niu, Brian Hollenbeck, Darren Z. Nin, David C. Chang: None References Smith EL, Shahien AA, Chung M, Stoker G, Niu R, Schwarzkopf R. 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In: ASMBS. https://pharmaceutical-journal.com/wp-content/uploads/2024/06/Obesity-management-ASMBS-Poster-2024_D3_24052389-Read-Only.pdf Tables Table 1A. Characteristics among total knee arthroplasty patients by different weight loss strategies (N=20,604) Without weight loss strategies (control group) GLP-1 RAs P value 1 MBS P value 2 Patient number 19,401 1,033 170 Mean age (SD) 61.9 (8.8) 58.6 (7.2) <0.001 56.1 (7.3) <0.001 Women 11,638 (60.0%) 680 (65.8%) 0.001 133 (78.2%) <0.001 Region Northeast 2,057 (10.6%) 145 (14.0%) <0.001 13 (7.6%) 0.016 Midwest 7,579 (39.1%) 279 (27.0%) 57 (33.5%) South 8,019 (41.3%) 532 (51.5%) 74 (43.5%) West 1,740 (9.0%) 77 (7.5%) 26 (15.3%) Comorbidities Diabetes 5,030 (25.9%) 753 (72.9%) <0.001 62 (36.5%) 0.002 Hypertension 14,299 (73.7%) 847 (82.0%) <0.001 139 (81.8%) 0.017 Hypercholesterolemia 12,700 (65.5%) 792 (76.7%) <0.001 105 (61.8%) 0.31 Cancer 2,067 (10.7%) 81 (7.8%) 0.004 13 (7.6%) 0.21 Year of TKA 2021 9,702 (50.0%) 360 (34.8%) <0.001 89 (52.4%) 0.54 2022 9,699 (50.0%) 673 (65.2%) 81 (47.6%) BMI 30-34.9 4,342 (35.8%) 141 (19.6%) <0.001 4 (2.5%) <0.001 35-39.9 3,686 (30.4%) 212 (29.4%) 19 (11.8%) ≥ 40 3,871 (31.9%) 363 (50.3%) 138 (85.7%) 1: P value comparing no weight loss strategies and GLP-1 RAs; 2: P value comparing no weight loss strategies and MBS. Abbreviations: total knee arthroplasty (TKA); glucagon-like peptide-1 receptor agonists (GLP-1 RAs); metabolic and bariatric surgery (MBS); standard deviation (SD); body mass index (BMI). Table 1B. Characteristics among total hip arthroplasty patients by different weight loss strategies (N=10,696) Without weight loss strategies (control group) GLP-1 RAs P value 1 MBS P value 2 Patient number 10,198 417 81 Mean age (SD) 60.8 (10.0) 58.0 (7.8) <0.001 54.7 (8.7) <0.001 Women 5,002 (49.0%) 227 (54.4%) 0.031 54 (66.7%) 0.002 Region Northeast 1,277 (12.5%) 49 (11.8%) <0.001 16 (19.8%) 0.26 Midwest 3,992 (39.2%) 117 (28.1%) 29 (35.8%) South 3,958 (38.8%) 221 (53.0%) 30 (37.0%) West 969 (9.5%) 30 (7.2%) 6 (7.4%) Comorbidities Diabetes 2,381 (23.3%) 284 (68.1%) <0.001 21 (25.9%) 0.58 Hypertension 7,226 (70.9%) 336 (80.6%) <0.001 67 (82.7%) 0.019 Hypercholesterolemia 6,562 (64.3%) 309 (74.1%) <0.001 45 (55.6%) 0.10 Cancer 1,139 (11.2%) 45 (10.8%) 0.81 3 (3.7%) 0.033 Year of THA 2021 5,116 (50.2%) 164 (39.3%) <0.001 38 (46.9%) 0.56 2022 5,082 (49.8%) 253 (60.7%) 43 (53.1%) BMI 30-34.9 2,707 (43.6%) 57 (19.3%) <0.001 3 (3.9%) <0.001 35-39.9 1,767 (28.5%) 72 (24.4%) 7 (9.1%) ≥ 40 1,567 (25.2%) 163 (55.3%) 67 (87.0%) 1: P value comparing no weight loss strategies and GLP-1 RAs; 2: P value comparing no weight loss strategies and MBS. Abbreviations: total hip arthroplasty (THA); glucagon-like peptide-1 receptor agonists (GLP-1 RAs); metabolic and bariatric surgery (MBS); standard deviation (SD); body mass index (BMI). Additional Declarations Yes there is potential conflict of interest. Supplementary Files Supplementtable.docx Codes to identify variables Cite Share Download PDF Status: Under Review Version 1 posted Review # 1 received at journal 06 Nov, 2025 Reviewer # 1 agreed at journal 25 Oct, 2025 Reviewers invited by journal 15 Oct, 2025 Submission checks completed at journal 03 Sep, 2025 First submitted to journal 02 Sep, 2025 Unknown event 01 Sep, 2025 Editor assigned by journal 29 Aug, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Playter","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA1klEQVRIiWNgGAWjYBACCQbmBjCDn4GBjZlILYxALQkMDJINJGsxOECsFsnZjY2feX/Y5Bvfbj72uIDBJl/egYAWaZmDzdI8CWmW2+4cSzeewZBmufEAAS1yEokNQC2HDcxu5JhJ8zAcNjBsIKyl+TdPwn8D4xn534jTIi2R2Aa05YCBgUQOG1iLPAEdDJJzDrZZzklLNpC4kWZuzGOQZmBASIvE7ebDN97Y2Bnwz0h+9pinwsZAnpDDgBHDwMQD5xmAI4iwFsYfyAKEbRkFo2AUjIKRBgD28DpPG5zhAwAAAABJRU5ErkJggg==","orcid":"https://orcid.org/0009-0005-1980-9429","institution":"New England Baptist Hospital","correspondingAuthor":true,"prefix":"","firstName":"Katharine","middleName":"","lastName":"Playter","suffix":""},{"id":530224626,"identity":"ede2eac5-665a-4424-93f3-8813d8d4ff74","order_by":1,"name":"Yuan-Hsin Chen","email":"","orcid":"","institution":"Massachusetts General Hospital","correspondingAuthor":false,"prefix":"","firstName":"Yuan-Hsin","middleName":"","lastName":"Chen","suffix":""},{"id":530224627,"identity":"92748254-b62c-4831-8076-a191d32847ec","order_by":2,"name":"Andrew Grant","email":"","orcid":"","institution":"New England Baptist Hospital","correspondingAuthor":false,"prefix":"","firstName":"Andrew","middleName":"","lastName":"Grant","suffix":""},{"id":530224628,"identity":"18e3c1b5-e895-450d-bba0-cfc12b3a074c","order_by":3,"name":"Ya-Wen Chen","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Ya-Wen","middleName":"","lastName":"Chen","suffix":""},{"id":530224629,"identity":"b7db81ce-cb56-45aa-b0f4-f6b71e95a78d","order_by":4,"name":"Hannah Travers","email":"","orcid":"","institution":"New England Baptist Hospital","correspondingAuthor":false,"prefix":"","firstName":"Hannah","middleName":"","lastName":"Travers","suffix":""},{"id":530224630,"identity":"1f97d8b1-8347-4aec-a345-a9ad282c3980","order_by":5,"name":"Brian Hollenbeck","email":"","orcid":"","institution":"New England Baptist Hospital","correspondingAuthor":false,"prefix":"","firstName":"Brian","middleName":"","lastName":"Hollenbeck","suffix":""},{"id":530224631,"identity":"65a17568-9ec6-4281-b159-06d3e36eb2e7","order_by":6,"name":"Darren Nin","email":"","orcid":"","institution":"Rush University, Rush Medical College","correspondingAuthor":false,"prefix":"","firstName":"Darren","middleName":"","lastName":"Nin","suffix":""},{"id":530224632,"identity":"faf4d8db-1c4a-4882-9dc2-cce344731ed4","order_by":7,"name":"Ruijia Niu","email":"","orcid":"","institution":"New England Baptist Hospital","correspondingAuthor":false,"prefix":"","firstName":"Ruijia","middleName":"","lastName":"Niu","suffix":""},{"id":530224633,"identity":"c7c490b3-fcaf-4a17-989c-c596bf4f4a69","order_by":8,"name":"Carl Talmo","email":"","orcid":"","institution":"New England Baptist Hospital","correspondingAuthor":false,"prefix":"","firstName":"Carl","middleName":"","lastName":"Talmo","suffix":""},{"id":530224634,"identity":"43eebaa4-b6cc-49af-a4eb-e103a5bdb38f","order_by":9,"name":"David Chang","email":"","orcid":"","institution":"Massachusetts General Hospital","correspondingAuthor":false,"prefix":"","firstName":"David","middleName":"","lastName":"Chang","suffix":""},{"id":530224635,"identity":"32ac3d25-75b4-46a0-a614-683884213992","order_by":10,"name":"Eric Smith","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Eric","middleName":"","lastName":"Smith","suffix":""}],"badges":[],"createdAt":"2025-08-29 18:10:10","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7490872/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7490872/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":94729859,"identity":"78cafd59-daee-47f2-bc24-fded94a5a059","added_by":"auto","created_at":"2025-10-30 07:05:26","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":34858,"visible":true,"origin":"","legend":"","description":"","filename":"Figure1A.docx","url":"https://assets-eu.researchsquare.com/files/rs-7490872/v1/1dfb6caa327c5f48c0a36f2e.docx"},{"id":94709538,"identity":"76fe0e2b-4a76-479a-aa3d-f393b98228db","added_by":"auto","created_at":"2025-10-30 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01:07:54","extension":"xml","order_by":7,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":121154,"visible":true,"origin":"","legend":"","description":"","filename":"2025IJO014960enriched.xml","url":"https://assets-eu.researchsquare.com/files/rs-7490872/v1/f196103fa36d0c8dcf3c9fe8.xml"},{"id":94709555,"identity":"d2522529-678d-4465-a79d-d5776c69c0f2","added_by":"auto","created_at":"2025-10-30 01:07:54","extension":"eps","order_by":8,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":135594,"visible":true,"origin":"","legend":"","description":"","filename":"drawingimage1.eps","url":"https://assets-eu.researchsquare.com/files/rs-7490872/v1/5e949b3a06dee0719a7b80da.eps"},{"id":94730013,"identity":"4158b2ae-8f6f-44b1-88f1-7402abe38842","added_by":"auto","created_at":"2025-10-30 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01:07:54","extension":"html","order_by":13,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":131254,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7490872/v1/a1127b58449b44d4616e2b0e.html"},{"id":94709543,"identity":"44c59306-f64a-41b4-84ec-d2d57319ac27","added_by":"auto","created_at":"2025-10-30 01:07:53","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":65896,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFigure 1A. Trends of metabolic and bariatric surgery and glucagon-like peptide-1 receptor agonists usage among patients underwent total knee arthroplasty\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAbbreviations: metabolic and bariatric surgery (MBS); glucagon-like peptide-1 receptor agonists (GLP-1 RAs); total knee arthroplasty (TKA).\u003c/p\u003e","description":"","filename":"1a.png","url":"https://assets-eu.researchsquare.com/files/rs-7490872/v1/a7de4379faa6100d5adce6a5.png"},{"id":94709537,"identity":"474cd422-79ac-47c0-b525-da9016a32144","added_by":"auto","created_at":"2025-10-30 01:07:53","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":62343,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFigure 1B. Trends of metabolic and bariatric surgery and glucagon-like peptide-1 receptor agonists usage among patients underwent total hip arthroplasty\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAbbreviations: metabolic and bariatric surgery (MBS); glucagon-like peptide-1 receptor agonists (GLP-1 RAs); total hip arthroplasty (THA).\u003c/p\u003e","description":"","filename":"1b.png","url":"https://assets-eu.researchsquare.com/files/rs-7490872/v1/8466935f2c86c4847bd34d39.png"},{"id":94729788,"identity":"9b9d5200-beff-4f4f-ab12-09a0cc628e3c","added_by":"auto","created_at":"2025-10-30 07:05:24","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":53557,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFigure 2A. Odds ratio of undergoing glucagon-like peptide-1 receptor agonists among total knee arthroplasty patients.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMultivariable logistic regression was conducted, adjusting for patient characteristics such as sex, age, region, year of surgery, diabetes, hypertension, hypercholesterolemia, and cancer. Abbreviations: glucagon-like peptide-1 receptor agonists (GLP-1 RAs); odds ratio (OR); confidence interval (CI); total knee arthroplasty (TKA).\u003c/p\u003e","description":"","filename":"2a.png","url":"https://assets-eu.researchsquare.com/files/rs-7490872/v1/37f86aa5c98a9c3ae2180c24.png"},{"id":94729118,"identity":"ca7eb4ab-49d0-43d2-a5df-4e0687891d4f","added_by":"auto","created_at":"2025-10-30 07:04:37","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":52665,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFigure 2B. Odds ratio of undergoing glucagon-like peptide-1 receptor agonists among total hip arthroplasty patients.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMultivariable logistic regression was conducted, adjusting for patient characteristics such as sex, age, region, year of surgery, diabetes, hypertension, hypercholesterolemia, and cancer. Abbreviations: glucagon-like peptide-1 receptor agonists (GLP-1 RAs); odds ratio (OR); confidence interval (CI); total hip arthroplasty (THA).\u003c/p\u003e","description":"","filename":"2b.png","url":"https://assets-eu.researchsquare.com/files/rs-7490872/v1/bbdddee75054af28c729002e.png"},{"id":94827198,"identity":"b5a0b121-231d-43b7-a689-91792b30bc43","added_by":"auto","created_at":"2025-10-31 06:55:42","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1242203,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7490872/v1/94fd8c90-841d-40ff-91fd-95c410200112.pdf"},{"id":94709544,"identity":"9fe650ee-4aa0-48cb-9732-c779988fe7a4","added_by":"auto","created_at":"2025-10-30 01:07:53","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":13700,"visible":true,"origin":"","legend":"Codes to identify variables","description":"","filename":"Supplementtable.docx","url":"https://assets-eu.researchsquare.com/files/rs-7490872/v1/473f3489916644a14433139c.docx"}],"financialInterests":"\u003cb\u003eYes\u003c/b\u003e there is potential conflict of interest.","formattedTitle":"Trends in Glucagon-like peptide-1 Receptor Agonists for Weight Loss Prior to Total Joint Arthroplasty","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eObesity is a prevalent and considerable challenge in total joint arthroplasty (TJA) due to the increased risk of complications.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e,\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e Preoperative optimization of this comorbidity is crucial, and the American Association of Hip and Knee Surgeons recommends a body mass index (BMI) cutoff of 40 for safe TJA.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e,\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e Many patients with obesity often have arthritis necessitating surgery and, therefore, utilize weight loss strategies to become eligible for TJA.\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e,\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e Metabolic and bariatric surgery (MBS) is an established method for achieving preoperative weight loss in TJA candidates. However, the indications for MBS limit patient eligibility, and concerns about surgical risks deter patients with comorbidities.\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eRecently, non-surgical interventions have been shown to be effective in reducing BMI before surgery.\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e,\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e Glucagon-like peptide 1 receptor agonists (GLP-1 RAs) are established treatments for glycemic control in diabetes and have been increasingly utilized for weight loss following Food and Drug Administration approval.\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e,\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e Multiple studies have explored the impact of GLP-1 RAs in orthopaedics, with some indicating a beneficial effect on bone mineral density and fracture risk.\u003csup\u003e\u003cspan additionalcitationids=\"CR12 CR13\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e Additionally, recent research has discussed their potential role in preoperative weight loss for TJA.\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e,\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e,\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e However, the extent of their usage and implications in TJA have not yet been comprehensively demonstrated.\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e,\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e,\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eThe rapid increase in GLP-1 RAs utilization warrants further investigation. Although studies have found that GLP-1 RAs may be disease-modifying therapies for knee osteoarthritis by mediating weight loss as well as inflammatory pathways, their perioperative impacts remain uncertain,\u003csup\u003e\u003cspan additionalcitationids=\"CR20 CR21\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e with some studies reporting risks of kidney injury, myocardial infarction, and pneumonia, while others have found no significant risks.\u003csup\u003e\u003cspan additionalcitationids=\"CR24\" citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e There is limited data on whether there has been a significant change in the strategies used for weight loss in the TJA population. Therefore, we aim to identify patient demographics and characteristics associated with GLP-1 RAs usage or MBS interventions in the TJA population.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\n \u003ch2\u003eData Source\u003c/h2\u003e\n \u003cp\u003eThe MarketScan Database includes over 273\u0026nbsp;million unique patients annually, comprising insured employees, retirees, their spouses, and dependents under employer-sponsored private health insurance in the United States.\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e The databases enable longitudinal tracking of patients across different institutions and providers. The Commercial Claims and Encounters database contains medical and pharmaceutical data sourced from employers and health plans. This study was approved by the New England Baptist Hospital Institutional Review Board.\u003c/p\u003e\n\u003c/div\u003e\n\u003ch3\u003eCohort Selection\u003c/h3\u003e\n\u003cp\u003eWe conducted a retrospective study that included patients with obesity who had an inpatient admission and underwent total hip arthroplasty (THA; Current Procedural Terminology [CPT] 27130) or total knee arthroplasty (TKA; CPT 27447) between January 1, 2021 and December 31, 2022. Obesity was identified via the International Classification of Diseases, 10th Revision (ICD-10) codes (Supplement Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e). Patients without continuous enrollment during the study period and patients who used non-GLP-1 RAs weight loss drugs within 1 year prior to TJA were excluded. These weight loss drugs were Bupropion-naltrexone (Contrave/Mysimba), Orlistat (Xenical, Alli), Phentermine-topiramate (Qsymia), and Setmelanotide (Imcivree).\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\n\u003ch3\u003eDefining Weight Loss Interventions and Covariates\u003c/h3\u003e\n\u003cp\u003ePatients were identified to have utilized GLP-1 RAs or undergone MBS within a year leading up to TJA. GLP-1 RAs included liraglutide, semaglutide, and tripeptide. Covariates were patient demographics, comorbidities, and year of TJA. Patient demographics included age, sex, and geographic region (Northeast, Midwest, South, or West). Patient comorbidities were diabetes, hypertension, hypercholesterolemia, and cancer, identified with ICD-10 codes.\u003c/p\u003e\n\u003ch3\u003eData Analyses\u003c/h3\u003e\n\u003cp\u003eThe demographic, geographic, and temporal characteristics of GLP-1 RAs and MBS utilization were assessed using \u003cem\u003eChi\u003c/em\u003e-squared analyses. Multivariate logistic regressions were performed, adjusting for patient demographics, comorbidities, and year of TJA using STATA (Version.17.0; StataCorp). Additionally, we conducted a sensitivity analysis to test whether a subgroup of TJA patients with obesity and without diabetes exhibited similar trends. This analysis was performed because GLP-1 RAs are commonly prescribed for diabetic patients. By focusing on non-diabetic patients, we can evaluate the use of GLP-1 RAs for weight loss beyond diabetes management. A \u003cem\u003eP\u003c/em\u003e-value cutoff of \u0026lt;\u0026thinsp;0.05 was used for statistical significance. All effect estimates were reported with corresponding 95% confidence intervals (CIs).\u003c/p\u003e\n\u003ch3\u003eBaseline Population Demographics\u003c/h3\u003e\n\u003cp\u003eA total of 31,300 patients were included in the study, with a median age of 61 years (Interquartile range, 56 to 66) and 17,734 (56.7%) women. There were 20,604 (65.8%) patients who underwent TKA, and 10,696 (34.2%) patients who underwent THA.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\u003ch2\u003ePatient Characteristics with GLP-1 RAs and MBS Usage among TKA Patients\u003c/h2\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e1\u003c/span\u003eA shows that patients who received GLP-1 RAs before TKA (n\u0026thinsp;=\u0026thinsp;1,033) were significantly younger average age and were more likely to be women. These patients were also more likely to be diagnosed with higher BMI, diabetes, hypertension, hypercholesterolemia, and cancer compared to patients who did not receive GLP-1 RAs. Additionally, patients who received MBS before TKA (n\u0026thinsp;=\u0026thinsp;170) exhibited similar characteristics but did not demonstrate higher likelihood of hypercholesterolemia and cancer. Figure\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e1\u003c/span\u003eA illustrates the trend of GLP-1 RAs and MBS usage among TKA patients from 2021 to 2022. There was a significant increase in the use of GLP-1 RAs among TKA patients in 2022 compared to 2021, while the usage of MBS remained relatively stable over this period.\u003c/p\u003e\u003cp\u003eIn the adjusted analysis (Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e2\u003c/span\u003eA), patients using GLP-1 RAs before TKA were more likely to be women (odds ratio [OR] 1.50, 95% CI 1.30\u0026ndash;1.72, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) or aged under 55. Specifically, the likelihood of using GLP-1 RAs decreased with age (OR for ages 55\u0026ndash;59, 60\u0026ndash;64, and \u0026ge;\u0026thinsp;65 were 0.78, 0.69, and 0.21, respectively; all \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026le;\u0026thinsp;0.01). Moreover, there was a significant increase in GLP-1 RAs usage in 2022 compared to 2021 (OR 1.88, 95% CI 1.64\u0026ndash;2.15, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). On sensitivity analysis focusing on TKA patients with obesity and without diabetes TKA patients, the results were consistent with the overall findings. Among non-diabetic patients, the usage of GLP-1 RAs also increased from 2021 to 2022.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003ePatient Characteristics with GLP-1 RAs and MBS Usage among THA Patients\u003c/h3\u003e\n\u003cp\u003eThe results among THA patients are qualitatively similar. As shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e1\u003c/span\u003eB, patients who received GLP-1 RAs before THA (n\u0026thinsp;=\u0026thinsp;417) were significantly younger and more likely to be women. These patients were also more likely to be diagnosed with higher BMI, diabetes, hypertension, and hypercholesterolemia compared to those who did not receive GLP-1 RAs. For patients who received MBS before THA (n\u0026thinsp;=\u0026thinsp;81), similar characteristics were observed, except for the absence of diabetes and hypercholesterolemia. The trend in the use of GLP-1 RAs and MBS among THA patients from 2021 to 2022 is depicted in Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e1\u003c/span\u003eB. There was a marked increase in the use of GLP-1 RAs among THA patients in 2022 compared to 2021, while the usage of MBS remained relatively stable during this period.\u003c/p\u003e\u003cp\u003eAdjusted analysis (Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e2\u003c/span\u003eB) revealed that patients using GLP-1 RAs before THA were more likely to be women (OR 1.55, 95% CI 1.26\u0026ndash;1.90, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and less likely to age 60 or older. Furthermore, there was a significant increase in GLP-1 RAs usage in 2022 compared to 2021 (OR 1.57, 95% CI 1.28\u0026ndash;1.94, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). In the sensitivity analysis focusing on THA patients with obesity and without diabetes, we observed similar results. The usage of GLP-1 RAs among non-diabetic patients increased from 2021 to 2022.\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eGiven the rapid increase in the utilization of GLP-1 RAs in the United States and theoretical implications for its usage in the TJA patients, we sought to better characterize the trends of GLP-1 RAs usage in this population. Our study found that patients with obesity using GLP-1 RAs prior to TKA or THA were more likely to be women or aged under 55. Also, among patients who underwent TKA or THA, the usage of GLP-1 RAs increased from 2021 to 2022, while the rates of MBS remained relatively stable over the same period. The increasing trend of GLP-1 RAs usage was observed in both diabetic and non-diabetic patients.\u003c/p\u003e\u003cp\u003eThe literature on the demographic characteristics of GLP-1 RAs usage in TJA is limited. Most previous studies did not focus on surgical patients. Among the general population, GLP-1 RAs users are more likely to be women and younger compared to non-users.\u003csup\u003e\u003cspan additionalcitationids=\"CR29\" citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e According to a report done by Blue Cross Blue Shield Association, the majority of GLP-1 RAs users were women and between ages of 35 and 54.\u003csup\u003e\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e Besides, a recent study similarly indicated that new GLP-1 RAs users were disproportionately women.\u003csup\u003e\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e To the best of our knowledge, our analysis of the demographic trends of GLP-1 RAs use in TJA is novel, revealing that GLP-1 RAs users were more likely to be under 55 or women. This finding aligns with the higher morbidity rates associated with elderly patients, making it reasonable that GLP-1 RAs users tend to be younger.\u003csup\u003e\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u003c/sup\u003e However, the association between women and higher GLP-1 RAs use remains unclear. It is possible that women often seek medical care more regularly and are more proactive in weight management, which may account for the higher prevalence of GLP-1 RAs use among them.\u003csup\u003e\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eA recent report by the American Academy of Orthopaedic Surgeons demonstrated an increasing trend in the use of GLP-1 RAs before TJA from 2019 to 2023 among patients with a BMI between 35 and 45.\u003csup\u003e\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u003c/sup\u003e Additionally, an evidence shows that more new prescriptions for GLP-1 RAs have been written in recent years, with the proportion of new users with a BMI of 30 or higher rising from 47% to over 66% from 2011 to 2023.\u003csup\u003e\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e Our study expands the current understanding by demonstrating that patients with obesity increased their usage of GLP-1 RAs before TJA, and this trend was observed among both diabetic and non-diabetic patients. This suggests that GLP-1 RAs represent a strong option for patients needing to lose weight prior to TJA. A recent editorial even suggested that GLP-1 RAs could increase the number of eligible patients for elective TJA.\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e On the other hand, our study showed that the volume of MBS remained relatively stable from 2021 to 2022. This seems to conflict with the understanding that the rising popularity of GLP-1 RAs might reduce the demand for MBS.\u003csup\u003e\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u003c/sup\u003e It is unclear why MBS didn\u0026rsquo;t decrease in the present study. The possible reason for this may be that GLP-1 RAs and MBS are not at odds, due to the effectiveness and durability of weight loss. A systematic review found that MBS produces greater and more durable weight loss than GLP-1 RAs, while the effects of GLP-1 RAs are durable only with sustained use of the medications.\u003csup\u003e\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e\u003c/sup\u003e Furthermore, sustained weight loss from MBS is associated with a lower risk of comorbidities. Therefore, both GLP-1 RAs and MBS have a place in providing treatment options for patients needing to lose weight.\u003c/p\u003e\u003cp\u003eOur study has several strengths. It utilized a nationwide commercial claims database, allowing for a representative exploration of trends in the use of GLP-1 RAs and MBS. This database also enabled longitudinal tracking of patients across various providers and facilities, enhancing the generalizability of our findings. However, there are limitations to our study. We did not include most patients with Medicare, as our analysis utilized a commercial claims database. Despite this exclusion, the elderly represent a relatively small proportion of those undergoing weight loss interventions, so our results remain valid even without their inclusion.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eOur study found that patients who aged under 55 and women were more likely to utilize MBS or GLP-1 RAs. We also identified a significant increase in the proportion of TJA patients utilizing GLP-1 RAs from 2021 to 2022 that seemed to be independent of diabetes status. We anticipate that the findings of this study will increase physician awareness of the strategies being utilized in their patient population, and aid them and their patients in choosing a weight loss intervention when necessary prior to TJA.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eConflict of Interest Statement: \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eKatharine Playter owns stock in Intuitive Surgical \u0026amp; Medtronic\u003c/p\u003e\n\u003cp\u003eCarl T. Talmo is an employee of Astra-Zeneca, receives IP royalties for DJ Orthopaedics, and is a paid consultant for Zimmer and DJ Orthopaedics\u003c/p\u003e\n\u003cp\u003eEric L. Smith Receives IP royalties from DePuy Synthes, has other professional activities with DePuy Synthes and ConforMIS, Inc, and is on the board of directors or is a committee member of AAOS, AAHKS, and The Knee Society\u003c/p\u003e\n\u003cp\u003eYuan-Hsin Chen, Andrew Grant, Ya-Wen Chen, Hannah I. Travers, Ruijia Niu, Brian Hollenbeck, Darren Z. Nin, David C. Chang: None\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSmith EL, Shahien AA, Chung M, Stoker G, Niu R, Schwarzkopf R. The Obesity Paradox: Body Mass Index Complication Rates Vary by Gender and Age Among Primary Total Hip Arthroplasty Patients. \u003cem\u003eJ Arthroplasty\u003c/em\u003e. 2020;35(9):2658\u0026ndash;2665. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.arth.2020.04.094\u003c/span\u003e\u003cspan address=\"10.1016/j.arth.2020.04.094\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZusmanovich M, Kester BS, Schwarzkopf R. 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Accessed July 23, 2024. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.aaos.org/aaosnow/2024/jun/clinical/clinical01/\u003c/span\u003e\u003cspan address=\"https://www.aaos.org/aaosnow/2024/jun/clinical/clinical01/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCenter for Metabolic and Weight Loss Surgery. State of the Union: Weight Loss Surgery in 2024. Columbia Surgery. Accessed July 23, 2024. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://columbiasurgery.org/news/state-union-weight-loss-surgery-2020\u003c/span\u003e\u003cspan address=\"https://columbiasurgery.org/news/state-union-weight-loss-surgery-2020\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJenkins ME, Hafermann JO, Fielding C, Prager G, Kurian M, Health NL. Effectiveness and durability of common weight loss methods. In: ASMBS. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://pharmaceutical-journal.com/wp-content/uploads/2024/06/Obesity-management-ASMBS-Poster-2024_D3_24052389-Read-Only.pdf\u003c/span\u003e\u003cspan address=\"https://pharmaceutical-journal.com/wp-content/uploads/2024/06/Obesity-management-ASMBS-Poster-2024_D3_24052389-Read-Only.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1A. Characteristics among total knee arthroplasty patients by different weight loss strategies (N=20,604)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"651\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.7192%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWithout weight loss strategies (control group)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 2.7915%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGLP-1 RAs\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.6732%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;value\u003csup\u003e1\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 2.7915%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMBS\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;value\u003csup\u003e2\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003ePatient number\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.7192%;\"\u003e\n \u003cp\u003e19,401\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 2.7915%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e1,033\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.6732%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 2.7915%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e170\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eMean age (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.7192%;\"\u003e\n \u003cp\u003e61.9 (8.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 2.7915%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e58.6 (7.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.6732%;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 2.7915%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e56.1 (7.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eWomen\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.7192%;\"\u003e\n \u003cp\u003e11,638 (60.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 2.7915%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e680 (65.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.6732%;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 2.7915%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e133 (78.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eRegion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.7192%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 2.7915%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.6732%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 2.7915%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Northeast\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.7192%;\"\u003e\n \u003cp\u003e2,057 (10.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 2.7915%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e145 (14.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.6732%;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 2.7915%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e13 (7.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.016\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Midwest\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.7192%;\"\u003e\n \u003cp\u003e7,579 (39.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 2.7915%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e279 (27.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.6732%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 2.7915%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e57 (33.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; South\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.7192%;\"\u003e\n \u003cp\u003e8,019 (41.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 2.7915%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e532 (51.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.6732%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 2.7915%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e74 (43.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; West\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.7192%;\"\u003e\n \u003cp\u003e1,740 (9.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 2.7915%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e77 (7.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.6732%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 2.7915%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e26 (15.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eComorbidities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.7192%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 2.7915%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.6732%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 2.7915%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eDiabetes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.7192%;\"\u003e\n \u003cp\u003e5,030 (25.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 2.7915%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e753 (72.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.6732%;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 2.7915%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e62 (36.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eHypertension\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.7192%;\"\u003e\n \u003cp\u003e14,299 (73.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 2.7915%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e847 (82.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.6732%;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 2.7915%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e139 (81.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.017\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eHypercholesterolemia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.7192%;\"\u003e\n \u003cp\u003e12,700 (65.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 2.7915%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e792 (76.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.6732%;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 2.7915%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e105 (61.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.31\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eCancer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.7192%;\"\u003e\n \u003cp\u003e2,067 (10.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 2.7915%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e81 (7.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.6732%;\"\u003e\n \u003cp\u003e0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 2.7915%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e13 (7.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.21\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eYear of TKA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.7192%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 2.7915%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.6732%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 2.7915%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 2021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.7192%;\"\u003e\n \u003cp\u003e9,702 (50.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 2.7915%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e360 (34.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.6732%;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 2.7915%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e89 (52.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.54\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 2022\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.7192%;\"\u003e\n \u003cp\u003e9,699 (50.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 2.7915%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e673 (65.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.6732%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 2.7915%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e81 (47.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eBMI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.7192%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 2.7915%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.6732%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 2.7915%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 30-34.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.7192%;\"\u003e\n \u003cp\u003e4,342 (35.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 2.7915%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e141 (19.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.6732%;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 2.7915%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e4 (2.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 35-39.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.7192%;\"\u003e\n \u003cp\u003e3,686 (30.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 2.7915%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e212 (29.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.6732%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 2.7915%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e19 (11.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026ge; 40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.7192%;\"\u003e\n \u003cp\u003e3,871 (31.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 2.7915%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e363 (50.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.6732%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 2.7915%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e138 (85.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e1: \u003cem\u003eP\u003c/em\u003e value comparing no weight loss strategies and GLP-1 RAs; 2: \u003cem\u003eP\u003c/em\u003e value comparing no weight loss strategies and MBS.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAbbreviations: total knee arthroplasty (TKA); glucagon-like peptide-1 receptor agonists (GLP-1 RAs); metabolic and bariatric surgery (MBS); standard deviation (SD); body mass index (BMI). \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1B. Characteristics among total hip arthroplasty patients by different weight loss strategies (N=10,696)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"651\" class=\"fr-table-selection-hover\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 128px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWithout weight loss strategies (control group)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGLP-1 RAs\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;value\u003csup\u003e1\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMBS\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;value\u003csup\u003e2\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003ePatient number\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e10,198\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e417\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e81\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eMean age (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e60.8 (10.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e58.0 (7.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e54.7 (8.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eWomen\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e5,002 (49.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e227 (54.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e0.031\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e54 (66.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eRegion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Northeast\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e1,277 (12.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e49 (11.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e16 (19.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.26\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Midwest\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e3,992 (39.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e117 (28.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e29 (35.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; South\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e3,958 (38.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e221 (53.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e30 (37.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; West\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e969 (9.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e30 (7.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e6 (7.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eComorbidities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eDiabetes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e2,381 (23.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e284 (68.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 96px;\"\u003e\n \u003cp\u003e21 (25.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.58\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eHypertension\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 128px;\"\u003e\n \u003cp\u003e7,226 (70.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 96px;\"\u003e\n \u003cp\u003e336 (80.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 96px;\"\u003e\n \u003cp\u003e67 (82.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.019\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eHypercholesterolemia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 128px;\"\u003e\n \u003cp\u003e6,562 (64.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 96px;\"\u003e\n \u003cp\u003e309 (74.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 96px;\"\u003e\n \u003cp\u003e45 (55.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eCancer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 128px;\"\u003e\n \u003cp\u003e1,139 (11.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 96px;\"\u003e\n \u003cp\u003e45 (10.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 96px;\"\u003e\n \u003cp\u003e3 (3.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.033\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eYear of THA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 2021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e5,116 (50.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e164 (39.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e38 (46.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.56\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 2022\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e5,082 (49.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e253 (60.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e43 (53.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eBMI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 30-34.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 128px;\"\u003e\n \u003cp\u003e2,707 (43.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 96px;\"\u003e\n \u003cp\u003e57 (19.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 96px;\"\u003e\n \u003cp\u003e3 (3.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 35-39.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 128px;\"\u003e\n \u003cp\u003e1,767 (28.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 96px;\"\u003e\n \u003cp\u003e72 (24.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 96px;\"\u003e\n \u003cp\u003e7 (9.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026ge; 40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 128px;\"\u003e\n \u003cp\u003e1,567 (25.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 96px;\"\u003e\n \u003cp\u003e163 (55.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 96px;\"\u003e\n \u003cp\u003e67 (87.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e1: \u003cem\u003eP\u003c/em\u003e value comparing no weight loss strategies and GLP-1 RAs; 2: \u003cem\u003eP\u003c/em\u003e value comparing no weight loss strategies and MBS.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAbbreviations: total hip arthroplasty (THA); glucagon-like peptide-1 receptor agonists (GLP-1 RAs); metabolic and bariatric surgery (MBS); standard deviation (SD); body mass index (BMI). \u0026nbsp;\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"international-journal-of-obesity","isNatureJournal":false,"hasQc":false,"allowDirectSubmit":false,"externalIdentity":"ijo","sideBox":"Learn more about [International Journal of Obesity](http://www.nature.com/ijo/)","snPcode":"41366","submissionUrl":"https://mts-ijo.nature.com/cgi-bin/main.plex","title":"International Journal of Obesity","twitterHandle":"@intjobesity","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"ejp","reportingPortfolio":"Nature AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-7490872/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7490872/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eObesity is a recognized risk factor for postoperative complications in total joint arthroplasty (TJA), and interventions to reduce weight are often performed for patients planning to undergo surgery. While metabolic and bariatric surgery (MBS) is an established method for achieving preoperative weight loss in TJA candidates, the popular glucagon-like peptide-1 receptor agonists (GLP-1 RAs) may have shifted the landscape of weight loss interventions. However, this trend and its characteristics have not been described. Therefore, this study aimed to identify patient demographics and characteristics associated with GLP-1 RAs usage or MBS interventions in the TJA population.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eThe MarketScan Database was queried to identify patients with obesity who had an inpatient admission and underwent primary total hip/knee arthroplasty (THA/TKA) between January 1, 2021 and December 31, 2022. The primary exposure was the utilization of GLP-1 RAs or MBS within the year before TJA. The demographic, geographic, and time of weight loss interventions were assessed. Multivariable logistic regressions were performed, adjusting for the above covariates.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eOur study identified 31,300 patients who underwent TKA (n\u0026thinsp;=\u0026thinsp;20,604) or THA (n\u0026thinsp;=\u0026thinsp;10,696). Patients with obesity using GLP-1 RAs were more likely to be women (TKA odds ratio [OR] 1.50, 95% CI 1.30\u0026ndash;1.72; THA OR 1.55, 95% CI 1.26\u0026ndash;1.90; both \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and aged under 55. The usage of GLP-1 RAs increased from 2021 to 2022 (TKA OR 1.88, 95% CI 1.64\u0026ndash;2.15; THA OR 1.57, 95% CI 1.28\u0026ndash;1.94; both \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), while the rates of MBS remained relatively stable over the same period. The increasing trend in GLP-1 RAs usage was observed in both diabetic and non-diabetic patients.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eOur study found that patients under 55 and women were more likely to utilize MBS or GLP-1 RAs prior to TJA. We also identified an increase in GLP-1 RAs usage from 2021 to 2022, independent of diabetes status.\u003c/p\u003e","manuscriptTitle":"Trends in Glucagon-like peptide-1 Receptor Agonists for Weight Loss Prior to Total Joint Arthroplasty","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-30 01:07:48","doi":"10.21203/rs.3.rs-7490872/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"This content is not available.","date":"2025-11-07T04:57:57+00:00","index":1,"fulltext":"This content is not available."},{"type":"reviewerAgreed","content":"This content is not available.","date":"2025-10-25T11:40:39+00:00","index":1,"fulltext":"This content is not available."},{"type":"reviewersInvited","content":"","date":"2025-10-15T18:01:21+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-03T14:13:53+00:00","index":"","fulltext":""},{"type":"submitted","content":"International Journal of Obesity","date":"2025-09-02T12:34:48+00:00","index":"","fulltext":""},{"type":"checksFailed","content":"","date":"2025-09-01T15:31:41+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-08-29T18:07:08+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"international-journal-of-obesity","isNatureJournal":false,"hasQc":false,"allowDirectSubmit":false,"externalIdentity":"ijo","sideBox":"Learn more about [International Journal of Obesity](http://www.nature.com/ijo/)","snPcode":"41366","submissionUrl":"https://mts-ijo.nature.com/cgi-bin/main.plex","title":"International Journal of Obesity","twitterHandle":"@intjobesity","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"ejp","reportingPortfolio":"Nature AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"189e3d06-9778-44cc-a82a-2df8190b44be","owner":[],"postedDate":"October 30th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[{"id":56365317,"name":"Health sciences/Health care/Therapeutics/Surgery/Bariatric surgery"},{"id":56365318,"name":"Health sciences/Health care/Weight management"},{"id":56365319,"name":"Health sciences/Risk factors"}],"tags":[],"updatedAt":"2025-10-30T01:07:49+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-30 01:07:48","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7490872","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7490872","identity":"rs-7490872","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}