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. 2026 Jan:58:104272.
doi: 10.1016/j.knee.2025.10.026. Epub 2025 Nov 14.

Association of preoperative GLP‑1 receptor agonist use with outcomes after primary total knee arthroplasty

McKenna W Box  1 , Troy B Puga  2 , Neil J Werthmann  2 , Andrew Jen  3 , Yingxian Liu  4 , John T Riehl  3
Affiliations

Association of preoperative GLP‑1 receptor agonist use with outcomes after primary total knee arthroplasty

McKenna W Box et al. Knee. 2026 Jan.

Abstract

Background: Evidence on whether glucagon-like peptide 1 receptor agonists (GLP-1RA) influence outcomes after total knee arthroplasty (TKA) is mixed. We evaluated the association between perioperative use of GLP-1RA and postoperative outcomes in patients with and without diabetes.

Methods: In this retrospective cohort from a single U.S. health system (2019-2023), adults undergoing primary TKA were stratified by GLP‑1RA use at the time of surgery. Primary outcomes included length-of-stay (LOS), 30-day medical complications, 90-day readmissions and surgical site infection (SSI), 1-year SSI, medical complications, and TKA implant complications, and revision TKA. Multivariable logistic regression and negative binomial regression were adjusted for age group, sex, BMI, smoking status, diabetes, and the Elixhauser Comorbidity Index. Unadjusted subgroup analyses examined outcomes by diabetes status and specific GLP-1RA agent.

Results: Among 26,154 TKA patients, 914 (3.5 %) used a GLP-1RA (73 % of these had diabetes). GLP-1RA use was associated with 45 % lower odds of 1-year implant complications (odds ratio = 0.55, 95 % CI 0.33-0.90, P = 0.02) and 10 % shorter LOS (incidence rate ratio = 0.90, 95 % CI 0.85-0.94, P < 0.001) (absolute difference of 0.17 days). No significant differences in 30-day complications, 90-day SSI, or readmissions were observed after adjustment.

Conclusions: Preoperative GLP-1RA use was associated with reduced one-year implant complications and slightly shorter hospital stays following TKA. These findings, although encouraging, are exploratory. Larger, adjusted analyses are needed to confirm the benefits before recommending changes in perioperative management.

Keywords: Arthroplasty; Complications; Diabetes mellitus; Glucagon-like peptide-1 receptor agonists; Implant-related complications; Obesity; Surgical outcomes; Total knee arthroplasty.

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Conflict of interest statement

Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: McKenna Box reports administrative support was provided by HCA Healthcare Inc. John T. Riehl reports a relationship with Arthrex Inc that includes: consulting or advisory. John T. Riehl reports a relationship with Skeletal Dynamics LLC that includes: speaking and lecture fees. This research received no specific grant from funding agencies in the public, commercial, or not-for-profit sectors. This research was supported (in whole or part) by HCA Healthcare and/ or an HCA Healthcare-affiliated entity. The views expressed in this publication represent those of the author(s) and do not necessarily represent the official views of HCA Healthcare or any affiliated entities. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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