The perioperative use of GLP-1 receptor agonists in patients undergoing hip and knee arthroplasty: a scoping review

Background: Glucagon-like peptide-1 receptor agonists (GLP-1As) are increasingly being used for managing obesity and type 2 diabetes mellitus (T2DM). As obesity is a risk factor for both osteoarthritis (OA) and total joint arthroplasty (TJA), GLP-1As are commonly prescribed to surgical candidates. However, the trends, outcomes, and complications associated with perioperative GLP-1A use in patients undergoing TJA are not yet fully understood. The aim of this review is to summarize the current evidence surrounding their perioperative use.

Methods: Four databases (EMBASE, MEDLINE, Scopus, and CINAHL) were searched to identify studies that investigated perioperative GLP-1As use in patients undergoing TJA. Relevant data was extracted and findings were described qualitatively in a concept map and table.

Results: A total of eleven studies were included in this review. Eight studies investigated the impact of perioperative GLP-1A use on outcomes following TJA, while three investigated the long-term conversion rate to TJA and development of OA associated with GLP-1A use. Two studies reported the impact on hemoglobin A1c (HbA1c) and/or body mass index (BMI), and ten studies reported complication rates associated with GLP-1A use. Mixed treatment effects and complication rates were found across all above outcome measures. Three studies reported the perioperative GLP-1A withholding period, all of which reported to withhold GLP-1A use 7 days prior to surgery.

Conclusions: This review provides a comprehensive overview of the literature investigating perioperative GLP-1A use in patients undergoing TJA. Based on available data, perioperative GLP-1A use may be associated with improved surgical outcomes following arthroplasty. However, there is uncertainty regarding postoperative complications associated with their use. Given the paucity of evidence, high-quality prospective studies with standardized protocols are needed to better assess their clinical impact.