Effects of Glucagon-Like Peptide-1 Receptor Agonists on Perioperative Outcomes in Hip and Knee Arthroplasty: A Systematic Review and Meta-Analysis

Effects of Glucagon-Like Peptide-1 Receptor Agonists on Perioperative Outcomes in Hip and Knee Arthroplasty: A Systematic Review and Meta-Analysis | 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 Research Article Effects of Glucagon-Like Peptide-1 Receptor Agonists on Perioperative Outcomes in Hip and Knee Arthroplasty: A Systematic Review and Meta-Analysis Aoife Brady, Ryan Roopnarinesingh, Robert Craig, Sohail Bampoe This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9197869/v1 This work is licensed under a CC BY 4.0 License Status: Under Revision Version 1 posted 13 You are reading this latest preprint version Abstract Background : Obesity is a modifiable risk factor for poorer outcomes in hip and knee arthroplasty patients. Weight loss prior to hip or knee arthroplasty has been shown to reduce postoperative complications. Glucagon-like-peptide-1 receptor agonists (GLP-1 RAs) are emerging non-invasive alternatives for weight loss. We aimed to understand the effects of these medications on perioperative outcomes and to explore their role in preoperative optimisation strategies. Methods : Studies that compared adults who underwent primary hip or knee arthroplasty with and without GLP-1 RA use were included. Non-randomised (cohort and case‒control) and randomised controlled trials were included. The following electronic databases were searched using the indexed terms for ‘orthopaedic surgery’ and ‘GLP-1 RA’ from inception to 1/10/25, with no language or publication date restrictions: the Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, Scopus, Embase via Ovid, ProQuest, PubMed and MEDLINE. Data extraction was conducted via the Covidence Systematic Review tool. The risk of bias for non-randomised studies was assessed via the ROBINS-I V2 tool. Publication bias across studies was evaluated via funnel plot symmetry. The GRADE classification was used to assess the certainty of evidence. We conducted a meta-analysis via Review Manager (RevMan) version 5.3. Two reviewers worked independently throughout the process, and a third reviewer was used to resolve any discrepancies. Results : We included a total of 6 retrospective cohort database studies involving over 48,000 hip or knee arthroplasty patients. There was a significantly reduced risk of revision (OR = 0.8 95% CI: 0.66–0.98; P = 0.03) and transfusion (OR = 0.55 95% CI: 0.41–0.73; P ≤ 0.0001) in the GLP-1 RA group for total hip or knee arthroplasty at 90 days post-surgery. There was no statistically significant difference between the groups in terms of the risk for respiratory complications (OR = 0.79 95% CI: 0.61–1.01; P = 0.06), acute kidney injury (AKI) (OR = 0.98 95% CI: 0.89–1.09; P = 0.76), aseptic loosening (OR = 0.72 95% CI: 0.44–1.18; P = 0.19), deep venous thrombosis (DVT) (OR = 0.89 95% CI: 0.77–1.03; P = 0.12), emergency department (ED) visits (OR = 0.93 95% CI: 0.83–1.03; P = 0.16), hematoma (OR = 0.63 95% CI: 0.29–1.37; P = 0.25), or periprosthetic fracture (OR = 1.08 95% CI: 0.74–1.58; P = 0.68) or sepsis (OR = 1.03 95% CI: 0.49–2.05; P = 0.83) at 90 days following total hip or knee arthroplasty. The overall risk of bias assessment via the ROBINS-I-V2 tool was moderate. The certainty of evidence for these findings was low according to the GRADE classification. Conclusion : In summary, we found that GLP-1 RAs are safe to use prior to hip and knee arthroplasty surgery and may play a role in preoperative optimisation to help improve postoperative outcomes. Prospective studies, including large randomised controlled trials, are needed to validate these correlations. GLP-1 RA Hip arthroplasty Knee arthroplasty Perioperative outcomes Full Text Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Revision Version 1 posted Editorial decision: Revision requested 08 May, 2026 Reviews received at journal 18 Apr, 2026 Reviews received at journal 17 Apr, 2026 Reviews received at journal 16 Apr, 2026 Reviews received at journal 12 Apr, 2026 Reviewers agreed at journal 12 Apr, 2026 Reviewers agreed at journal 08 Apr, 2026 Reviewers agreed at journal 06 Apr, 2026 Reviewers agreed at journal 06 Apr, 2026 Reviewers invited by journal 06 Apr, 2026 Editor assigned by journal 24 Mar, 2026 Submission checks completed at journal 24 Mar, 2026 First submitted to journal 23 Mar, 2026 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. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9197869","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":619851529,"identity":"aeec9b74-69a8-4665-9454-7d752d7c7910","order_by":0,"name":"Aoife Brady","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABCUlEQVRIiWNgGAWjYFACxoYPDAwHgIwExgcfKoA0M3MDIS2NM6BamA1nnAFpYSSkhYERpoVNmrcNYi9e9fztzY1Al93J52/PMZDgnVcbzd8O1PKjYhtOLRJnDjYCXfbMcsaZNwYGktuO5844zNjA2HPmNm5rbiS2P+ZhOGzAcCPHIMFw27HcBqAWZsY23FrkbyQ2Nv8BapEHajmQOOdY7nxCWgxAWhiAWgxu5Bg2HGyoyd1ASIshyC89Bs8MDM88K2ZsOHYgdyNQy0F8fpE73v6w4UfFHQO548nbf/+pqcudd/7wwQc/KvB4H+I8EMEBIg+D+QcIqIcB9gdAoo5IxaNgFIyCUTCSAABPYGhTE4H4jwAAAABJRU5ErkJggg==","orcid":"","institution":"University College London","correspondingAuthor":true,"prefix":"","firstName":"Aoife","middleName":"","lastName":"Brady","suffix":""},{"id":619851530,"identity":"7e8a5d02-a847-421c-b3e4-94bf04c4447a","order_by":1,"name":"Ryan Roopnarinesingh","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Ryan","middleName":"","lastName":"Roopnarinesingh","suffix":""},{"id":619851531,"identity":"87c6dbcc-b56f-4900-91d7-ea8d1906e96c","order_by":2,"name":"Robert Craig","email":"","orcid":"","institution":"University College London","correspondingAuthor":false,"prefix":"","firstName":"Robert","middleName":"","lastName":"Craig","suffix":""},{"id":619851532,"identity":"2ed784c6-65b8-4d5e-bb16-90f2d5060565","order_by":3,"name":"Sohail Bampoe","email":"","orcid":"","institution":"University College London","correspondingAuthor":false,"prefix":"","firstName":"Sohail","middleName":"","lastName":"Bampoe","suffix":""}],"badges":[],"createdAt":"2026-03-23 08:53:14","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9197869/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9197869/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":106664551,"identity":"f721c493-20be-43a2-8aca-7e1b5cd7524b","added_by":"auto","created_at":"2026-04-11 07:41:12","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1731849,"visible":true,"origin":"","legend":"","description":"","filename":"POMJsubmissionfinal1.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9197869/v1_covered_a61c790c-4e71-4c28-8271-1119775b7402.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Effects of Glucagon-Like Peptide-1 Receptor Agonists on Perioperative Outcomes in Hip and Knee Arthroplasty: A Systematic Review and Meta-Analysis","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"perioperative-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"peri","sideBox":"Learn more about [Perioperative Medicine](http://perioperativemedicinejournal.biomedcentral.com)","snPcode":"13741","submissionUrl":"https://submission.nature.com/new-submission/13741/3","title":"Perioperative Medicine","twitterHandle":"@EMSurgeryBMC","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"GLP-1 RA, Hip arthroplasty, Knee arthroplasty, Perioperative outcomes","lastPublishedDoi":"10.21203/rs.3.rs-9197869/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9197869/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e \u003cem\u003eBackground\u003c/em\u003e:\u003c/p\u003e \u003cp\u003eObesity is a modifiable risk factor for poorer outcomes in hip and knee arthroplasty patients. Weight loss prior to hip or knee arthroplasty has been shown to reduce postoperative complications. Glucagon-like-peptide-1 receptor agonists (GLP-1 RAs) are emerging non-invasive alternatives for weight loss. We aimed to understand the effects of these medications on perioperative outcomes and to explore their role in preoperative optimisation strategies.\u003c/p\u003e \u003cp\u003e \u003cem\u003eMethods\u003c/em\u003e:\u003c/p\u003e \u003cp\u003eStudies that compared adults who underwent primary hip or knee arthroplasty with and without GLP-1 RA use were included. Non-randomised (cohort and case‒control) and randomised controlled trials were included.\u003c/p\u003e \u003cp\u003eThe following electronic databases were searched using the indexed terms for \u0026lsquo;orthopaedic surgery\u0026rsquo; and \u0026lsquo;GLP-1 RA\u0026rsquo; from inception to 1/10/25, with no language or publication date restrictions: the Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, Scopus, Embase via Ovid, ProQuest, PubMed and MEDLINE.\u003c/p\u003e \u003cp\u003eData extraction was conducted via the Covidence Systematic Review tool. The risk of bias for non-randomised studies was assessed via the ROBINS-I V2 tool. Publication bias across studies was evaluated via funnel plot symmetry. The GRADE classification was used to assess the certainty of evidence. We conducted a meta-analysis via Review Manager (RevMan) version 5.3. Two reviewers worked independently throughout the process, and a third reviewer was used to resolve any discrepancies.\u003c/p\u003e \u003cp\u003e \u003cem\u003eResults\u003c/em\u003e:\u003c/p\u003e \u003cp\u003eWe included a total of 6 retrospective cohort database studies involving over 48,000 hip or knee arthroplasty patients. There was a significantly reduced risk of revision (OR\u0026thinsp;=\u0026thinsp;0.8 95% CI: 0.66\u0026ndash;0.98; P\u0026thinsp;=\u0026thinsp;0.03) and transfusion (OR\u0026thinsp;=\u0026thinsp;0.55 95% CI: 0.41\u0026ndash;0.73; P\u0026thinsp;\u0026le;\u0026thinsp;0.0001) in the GLP-1 RA group for total hip or knee arthroplasty at 90 days post-surgery. There was no statistically significant difference between the groups in terms of the risk for respiratory complications (OR\u0026thinsp;=\u0026thinsp;0.79 95% CI: 0.61\u0026ndash;1.01; P\u0026thinsp;=\u0026thinsp;0.06), acute kidney injury (AKI) (OR\u0026thinsp;=\u0026thinsp;0.98 95% CI: 0.89\u0026ndash;1.09; P\u0026thinsp;=\u0026thinsp;0.76), aseptic loosening (OR\u0026thinsp;=\u0026thinsp;0.72 95% CI: 0.44\u0026ndash;1.18; P\u0026thinsp;=\u0026thinsp;0.19), deep venous thrombosis (DVT) (OR\u0026thinsp;=\u0026thinsp;0.89 95% CI: 0.77\u0026ndash;1.03; P\u0026thinsp;=\u0026thinsp;0.12), emergency department (ED) visits (OR\u0026thinsp;=\u0026thinsp;0.93 95% CI: 0.83\u0026ndash;1.03; P\u0026thinsp;=\u0026thinsp;0.16), hematoma (OR\u0026thinsp;=\u0026thinsp;0.63 95% CI: 0.29\u0026ndash;1.37; P\u0026thinsp;=\u0026thinsp;0.25), or periprosthetic fracture (OR\u0026thinsp;=\u0026thinsp;1.08 95% CI: 0.74\u0026ndash;1.58; P\u0026thinsp;=\u0026thinsp;0.68) or sepsis (OR\u0026thinsp;=\u0026thinsp;1.03 95% CI: 0.49\u0026ndash;2.05; P\u0026thinsp;=\u0026thinsp;0.83) at 90 days following total hip or knee arthroplasty. The overall risk of bias assessment via the ROBINS-I-V2 tool was moderate. The certainty of evidence for these findings was low according to the GRADE classification.\u003c/p\u003e \u003cp\u003e \u003cem\u003eConclusion\u003c/em\u003e:\u003c/p\u003e \u003cp\u003eIn summary, we found that GLP-1 RAs are safe to use prior to hip and knee arthroplasty surgery and may play a role in preoperative optimisation to help improve postoperative outcomes. Prospective studies, including large randomised controlled trials, are needed to validate these correlations.\u003c/p\u003e","manuscriptTitle":"Effects of Glucagon-Like Peptide-1 Receptor Agonists on Perioperative Outcomes in Hip and Knee Arthroplasty: A Systematic Review and Meta-Analysis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-11 07:40:29","doi":"10.21203/rs.3.rs-9197869/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-05-08T15:16:47+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-18T18:40:07+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-17T16:13:41+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-16T06:43:33+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-12T09:18:34+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"73453493211361689557326893606738047779","date":"2026-04-12T09:11:01+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"85390838457269190863036902576991155518","date":"2026-04-08T16:30:44+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"190929761829513034243506524558040597362","date":"2026-04-06T20:43:15+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"81769591257381884623415736977336456244","date":"2026-04-06T15:16:05+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-06T14:05:41+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-25T01:02:42+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-25T01:02:38+00:00","index":"","fulltext":""},{"type":"submitted","content":"Perioperative Medicine","date":"2026-03-23T08:36:16+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"perioperative-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"peri","sideBox":"Learn more about [Perioperative Medicine](http://perioperativemedicinejournal.biomedcentral.com)","snPcode":"13741","submissionUrl":"https://submission.nature.com/new-submission/13741/3","title":"Perioperative Medicine","twitterHandle":"@EMSurgeryBMC","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ed17a017-5af9-4c80-8b31-5e9042f1b06c","owner":[],"postedDate":"April 11th, 2026","published":true,"recentEditorialEvents":[{"type":"decision","content":"Revision requested","date":"2026-05-08T15:16:47+00:00","index":"","fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"in-revision","subjectAreas":[],"tags":[],"updatedAt":"2026-05-08T16:25:31+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-11 07:40:29","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9197869","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9197869","identity":"rs-9197869","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}