Seungjun Lee, Kevin Singh, Sean C Clark, Graham S Goh
{"title":"胰高血糖素样肽-1受体激动剂对全髋关节置换术后临床结果的影响：346,899例患者的系统回顾和荟萃分析","authors":"Seungjun Lee, Kevin Singh, Sean C Clark, Graham S Goh","doi":"10.1016/j.arth.2025.09.054","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Obesity and diabetes are highly prevalent comorbidities in patients undergoing total hip (THA) and knee arthroplasty (TKA). Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are novel agents that promote weight loss and glycemic control, assisting with perioperative optimization and potentially improving clinical outcomes. However, there have been safety concerns surrounding GLP-1RA use due to delayed gastric emptying and increased aspiration risk. The purpose of this systematic review was to evaluate the impact of GLP-1RA usage on perioperative outcomes following THA and TKA.</p><p><strong>Methods: </strong>PubMed (MEDLINE), Scopus (EMBASE, MEDLINE, COMPENDEX), and Cochrane databases were queried to conduct a systematic review of articles from inception to June 2025. A total of 13 studies were included (119,092 hip, 227,381 knee, 426 hip or knee). Demographics, surgical complications, medical complications, resource utilization, and revision rates were recorded at 90 days and at one and two years. Meta-analysis was performed using a random-effects model.</p><p><strong>Results: </strong>The GLP-1RA use was associated with a lower risk of 90-day PJI following TKA (odds ratio (OR), 0.75; 95% confidence interval (CI), 0.57 to 1.00; P = 0.047) and a lower risk of 90-day revision following THA (OR, 0.76; 95% CI, 0.59 to 0.98; P = 0.034). There was a significant decrease in 90-day readmission rates for TKA and THA with GLP-1RA use. Of note, no significant association was found between GLP-1RA use and aspiration or pneumonia (OR, 1.09; 95% CI, 0.71 to 1.67; P = 0.70), but GLP-1RA usage was associated with an elevated risk of MI in the setting of TKA (OR, 1.39; 95% CI, 1.05 to 1.85; P = 0.02).</p><p><strong>Conclusion: </strong>The GLP-1RA use was associated with improved early surgical outcomes and decreased resource utilization following THA and TKA. These findings suggest a potential benefit of GLP-1RA use for optimizing high-risk patients who have obesity or diabetes undergoing TJA.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.8000,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"The Impact of Glucagon-Like Peptide-1 Receptor Agonist Use on Clinical Outcomes After Total Hip and Knee Arthroplasty: A Systematic Review and Meta-Analysis of 346,899 Patients.\",\"authors\":\"Seungjun Lee, Kevin Singh, Sean C Clark, Graham S Goh\",\"doi\":\"10.1016/j.arth.2025.09.054\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Obesity and diabetes are highly prevalent comorbidities in patients undergoing total hip (THA) and knee arthroplasty (TKA). Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are novel agents that promote weight loss and glycemic control, assisting with perioperative optimization and potentially improving clinical outcomes. However, there have been safety concerns surrounding GLP-1RA use due to delayed gastric emptying and increased aspiration risk. The purpose of this systematic review was to evaluate the impact of GLP-1RA usage on perioperative outcomes following THA and TKA.</p><p><strong>Methods: </strong>PubMed (MEDLINE), Scopus (EMBASE, MEDLINE, COMPENDEX), and Cochrane databases were queried to conduct a systematic review of articles from inception to June 2025. A total of 13 studies were included (119,092 hip, 227,381 knee, 426 hip or knee). Demographics, surgical complications, medical complications, resource utilization, and revision rates were recorded at 90 days and at one and two years. Meta-analysis was performed using a random-effects model.</p><p><strong>Results: </strong>The GLP-1RA use was associated with a lower risk of 90-day PJI following TKA (odds ratio (OR), 0.75; 95% confidence interval (CI), 0.57 to 1.00; P = 0.047) and a lower risk of 90-day revision following THA (OR, 0.76; 95% CI, 0.59 to 0.98; P = 0.034). There was a significant decrease in 90-day readmission rates for TKA and THA with GLP-1RA use. Of note, no significant association was found between GLP-1RA use and aspiration or pneumonia (OR, 1.09; 95% CI, 0.71 to 1.67; P = 0.70), but GLP-1RA usage was associated with an elevated risk of MI in the setting of TKA (OR, 1.39; 95% CI, 1.05 to 1.85; P = 0.02).</p><p><strong>Conclusion: </strong>The GLP-1RA use was associated with improved early surgical outcomes and decreased resource utilization following THA and TKA. These findings suggest a potential benefit of GLP-1RA use for optimizing high-risk patients who have obesity or diabetes undergoing TJA.</p>\",\"PeriodicalId\":51077,\"journal\":{\"name\":\"Journal of Arthroplasty\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":3.8000,\"publicationDate\":\"2025-10-08\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Arthroplasty\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.arth.2025.09.054\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"ORTHOPEDICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Arthroplasty","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.arth.2025.09.054","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
The Impact of Glucagon-Like Peptide-1 Receptor Agonist Use on Clinical Outcomes After Total Hip and Knee Arthroplasty: A Systematic Review and Meta-Analysis of 346,899 Patients.
Background: Obesity and diabetes are highly prevalent comorbidities in patients undergoing total hip (THA) and knee arthroplasty (TKA). Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are novel agents that promote weight loss and glycemic control, assisting with perioperative optimization and potentially improving clinical outcomes. However, there have been safety concerns surrounding GLP-1RA use due to delayed gastric emptying and increased aspiration risk. The purpose of this systematic review was to evaluate the impact of GLP-1RA usage on perioperative outcomes following THA and TKA.
Methods: PubMed (MEDLINE), Scopus (EMBASE, MEDLINE, COMPENDEX), and Cochrane databases were queried to conduct a systematic review of articles from inception to June 2025. A total of 13 studies were included (119,092 hip, 227,381 knee, 426 hip or knee). Demographics, surgical complications, medical complications, resource utilization, and revision rates were recorded at 90 days and at one and two years. Meta-analysis was performed using a random-effects model.
Results: The GLP-1RA use was associated with a lower risk of 90-day PJI following TKA (odds ratio (OR), 0.75; 95% confidence interval (CI), 0.57 to 1.00; P = 0.047) and a lower risk of 90-day revision following THA (OR, 0.76; 95% CI, 0.59 to 0.98; P = 0.034). There was a significant decrease in 90-day readmission rates for TKA and THA with GLP-1RA use. Of note, no significant association was found between GLP-1RA use and aspiration or pneumonia (OR, 1.09; 95% CI, 0.71 to 1.67; P = 0.70), but GLP-1RA usage was associated with an elevated risk of MI in the setting of TKA (OR, 1.39; 95% CI, 1.05 to 1.85; P = 0.02).
Conclusion: The GLP-1RA use was associated with improved early surgical outcomes and decreased resource utilization following THA and TKA. These findings suggest a potential benefit of GLP-1RA use for optimizing high-risk patients who have obesity or diabetes undergoing TJA.
期刊介绍：
The Journal of Arthroplasty brings together the clinical and scientific foundations for joint replacement. This peer-reviewed journal publishes original research and manuscripts of the highest quality from all areas relating to joint replacement or the treatment of its complications, including those dealing with clinical series and experience, prosthetic design, biomechanics, biomaterials, metallurgy, biologic response to arthroplasty materials in vivo and in vitro.
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