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GLP-1 Receptor Agonists and Orthopaedic Surgery

How GLP-1 receptor agonists (semaglutide and related drugs) affect orthopaedic and arthroplasty patients — perioperative risk, weight optimisation, bone and fracture healing, and infection or revision risk.

Overview

Glucagon-like peptide-1 (GLP-1) receptor agonists are increasingly utilized in orthopaedic practice, particularly for preoperative weight loss in patients with obesity and type-2 diabetes mellitus [5]. Arthroplasty surgeons will encounter a growing number of patients on these agents, necessitating an understanding of their perioperative implications [3]. While GLP-1 receptor agonists affect bone health and carry specific implications for spine surgery, their role in joint arthroplasty is defined by evolving outcome data [1].

Current evidence suggests that perioperative GLP-1 receptor agonist use in total hip or knee arthroplasty is associated with improved early surgical outcomes and decreased resource utilization [7]. These patients may also experience a reduced risk of postoperative infection and reduced readmission risk following joint arthroplasty, without evidence of increased postoperative medical harm [6]. However, findings remain inconsistent regarding broader complications; while some data indicate no significant association with 90-day or 2-year adverse events following total shoulder arthroplasty, further research is needed to clarify their impact on outcomes and establish standardized perioperative management guidelines [2, 4].

Regarding skeletal health, GLP-1 receptor agonists may provide benefits in type 2 diabetes mellitus by addressing mechanisms underlying diabetic osteopathy, with effects varying by agent type and treatment duration [16]. Exenatide is identified as the best option regarding fracture risk among this class [11]. Conversely, further investigation is required to elucidate the association between GLP-1-RA use and increased incidence of osteoarthritis diagnosis in patients with no preexisting osteoarthritis [15]. Due to the risks of hyperglycaemia and compromised weight control, elective preprocedural cessation of GLP-1 receptor agonists is not recommended due to insufficient data supporting cessation [10]. High-quality studies are needed to address optimal perioperative care for this expanding patient population [8, 9].

Effects on Surgery and Recovery

Arthroplasty Outcomes: Current observational data indicate that perioperative GLP-1 RA use in patients undergoing total hip or knee arthroplasty is not associated with a consistent increase in short-term revision rates [8]. GLP-1RA use was associated with improved early surgical outcomes and decreased resource utilization following total hip arthroplasty (THA) and total knee arthroplasty (TKA) [7]. Perioperative GLP-1 RA use in patients undergoing total hip or knee arthroplasty may be associated with a reduced risk of postoperative infection [8]. A meta-analysis of eight retrospective cohort studies involving over 76,000 arthroplasty patients found that GLP-1 RA use was associated with reduced risk of prosthetic joint infection (PJI) [18]. Preoperative glucagon-like peptide-1 receptor agonist use may be linked to reduced readmission risk following joint arthroplasty, without evidence of increased postoperative medical harm [6]. GLP-1 agonist use is not significantly associated with 90-day or 2-year adverse events following total shoulder arthroplasty [2].

Soft-Tissue and Hand Surgery: Perioperative GLP-1RA use was associated with a small yet statistically significant reduction in the odds of wound dehiscence following carpal tunnel release (CTR) [17]. Perioperative GLP-1RA use did not increase the odds of any other 90-day postoperative complications following carpal tunnel release (CTR) [17].

Gastric Aspiration Risk: Patients treated with GLP-1 RAs may retain considerable gastric contents even after standard preoperative fasting, thereby increasing the likelihood of regurgitation and aspiration during anesthesia induction or emergence [12]. Most studies reported an association between GLP-1 RA and increased residual gastric contents, but evidence linking these medications to a statistically significant rise in regurgitation or aspiration events remains highly inconsistent [20]. Available observational evidence suggests that extended GLP-1 RA withholding, 24-hour clear liquid diets, and pre-procedural gastric POCUS may be associated with reduced residual gastric content in selected patient populations [19].

Perioperative Management and Research Gaps: Elective preprocedural cessation of GLP-1RAs and GLP-1/GIPRAs is not recommended due to insufficient data supporting cessation and risks of hyperglycaemia and compromised weight control [10]. While GLP-1 receptor agonists show potential to reduce postoperative complications in total joint arthroplasty, findings remain inconsistent, and further research is needed to clarify their impact on outcomes and establish perioperative management guidelines [4]. Conflicting findings highlight the need for further research, particularly well-designed multicenter studies and randomized controlled trials, to clarify the effects of GLP-1 RAs on surgical outcomes [13]. Further investigation is needed to elucidate the association between GLP-1-RA use and the increased incidence of osteoarthritis diagnosis and conversion to TKA in patients with no preexisting OA [15].

Practical Considerations

GLP-1 receptor agonists serve as a promising tool for preoperative weight loss in patients with obesity and type-2 diabetes mellitus undergoing orthopaedic surgery [5]. Semaglutide and other agents may increase the pool of eligible candidates for elective total joint arthroplasty by enabling weight loss and improving diabetic control [14]. These medications may potentially reduce postoperative complications such as sepsis and prosthetic joint infections [14].

In patients undergoing total hip or knee arthroplasty, GLP-1RA use is associated with improved early surgical outcomes [7] and decreased resource utilization [7]. Preoperative use may be linked to reduced readmission risk following joint arthroplasty [6] and is not associated with evidence of increased postoperative medical harm [6]. Current observational data suggest that perioperative GLP-1 RA use is not associated with a consistent increase in short-term revision rates [8]. Perioperative use may also be associated with a reduced risk of postoperative infection [8].

For total shoulder arthroplasty, GLP-1 agonist use is not significantly associated with 90-day adverse events [2] or 2-year adverse events [2]. Exenatide is the best option agent with regard to the risk of fracture among GLP-1 receptor agonists [11].

Patients treated with GLP-1 RAs may retain considerable gastric contents even after standard preoperative fasting [12]. This retention increases the likelihood of regurgitation and aspiration during anesthesia induction or emergence [12].

Elective Preprocedural Cessation: Not recommended due to insufficient data supporting cessation [10]. Cessation is not recommended due to risks of hyperglycaemia [10]. Cessation is not recommended due to risks of compromised weight control [10].

Findings regarding the potential for GLP-1 receptor agonists to reduce postoperative complications in total joint arthroplasty remain inconsistent [4]. Further research is needed to clarify the impact of GLP-1 receptor agonists on outcomes in total joint arthroplasty [4]. Further research is needed to establish perioperative management guidelines for GLP-1 receptor agonists in total joint arthroplasty [4]. Conflicting findings regarding the effects of GLP-1 RAs on surgical outcomes highlight the need for further research [13]. Further well-designed multicenter studies are needed to clarify the effects of GLP-1 RAs on surgical outcomes [13]. Further randomized controlled trials are needed to clarify the effects of GLP-1 RAs on surgical outcomes [13]. High-quality studies are needed to address the optimal perioperative care of patients on GLP-1RAs [9].

Key Evidence

  • [L4] This narrative review explores the mechanisms of action of GLP-1 agonists, their effects on bone health, and the implications of their use in perioperative patients undergoing orthopedic surgery, with an emphasis on spine surgery. (10.1177/15563316261438492)
  • [L1] GLP-1 agonist use is not significantly associated with 90-day or 2-year adverse events following total shoulder arthroplasty. (10.1016/j.jse.2025.12.005)
  • [L5] Arthroplasty surgeons will encounter an increasing number of patients on GLP-1 agonists, making it important to understand the implications of their use in the perioperative period. (10.1016/j.arth.2023.12.002)
  • [L5] The paper concludes that while GLP-1 receptor agonists show potential to reduce postoperative complications in total joint arthroplasty, findings remain inconsistent, and further research is needed to clarify their impact on outcomes and establish perioperative management guidelines. (10.1016/j.arth.2025.10.027)
  • [L5] GLP-1 receptor agonists are a promising tool for preoperative weight loss in patients with obesity and type-2 diabetes mellitus undergoing orthopaedic surgery. (10.2106/jbjs.24.01287)
  • [L1] Preoperative glucagon-like peptide-1 receptor agonist use may be linked to reduced readmission risk following joint arthroplasty, without evidence of increased postoperative medical harm. (10.1016/j.arth.2025.11.036)
  • [L1] GLP-1RA use was associated with improved early surgical outcomes and decreased resource utilization following THA and TKA. (10.1016/j.arth.2025.09.054)
  • [L4] Current observational data suggest that perioperative GLP-1 RA use in patients undergoing total hip or knee arthroplasty is not associated with a consistent increase in short-term revision rates and may be associated with a reduced risk of postoperative infection. (10.1186/s42836-026-00375-w)
  • [L4] Due to the increasing popularity of GLP-1RAs in patients with obesity, the authors call for further high-quality studies to address the optimal perioperative care of patients on GLP-1RAs. (10.5114/ait/203167)
  • [L1] Exenatide is the best option agent with regard to the risk of fracture. (10.1007/s00198-018-4649-8)
  • [L4] Recent studies have shown that patients treated with GLP-1 RAs may retain considerable gastric contents even after standard preoperative fasting, thereby increasing the likelihood of regurgitation and aspiration during anesthesia induction or emergence. (10.3904/kjim.2025.277)
  • [L4] However, conflicting findings highlight the need for further research, particularly well-designed multicenter studies and randomized controlled trials, to clarify the effects of GLP-1 RAs on surgical outcomes. (10.1016/j.arth.2025.07.015)
  • [L5] Semaglutide and other GLP-1 agonists may increase the number of eligible candidates for elective total joint arthroplasty by enabling weight loss and improving diabetic control, while also potentially reducing postoperative complications such as sepsis and prosthetic joint infections. (10.1016/j.arth.2023.12.014)
  • [L3] Further investigation is needed to elucidate the association between GLP-1-RA use and the increased incidence of OA diagnosis and conversion to TKA in patients with no preexisting OA. (10.1177/23259671241297157)
  • [L1] GLP-1 RAs may provide skeletal benefits in T2DM patients by addressing specific mechanisms underlying diabetic osteopathy, with effects varying by agent type, patient characteristics, and treatment duration. (10.1186/s12891-025-09022-y)
  • [L3] Perioperative GLP-1RA use was associated with a small yet statistically significant reduction in the odds of wound dehiscence following CTR and did not increase the odds of any other 90-day postoperative complications. (10.1016/j.jhsg.2025.100746)
  • [L1] This meta-analysis of eight retrospective cohort studies involving over 76,000 arthroplasty patients found that GLP-1 RA use was associated with reduced risk of PJI. (10.1016/j.arth.2025.06.083)
  • [L4] Available observational evidence suggests that extended GLP-1 RA withholding, 24-hour clear liquid diets, and pre-procedural gastric POCUS may be associated with reduced residual gastric content in selected patient populations. (10.7759/cureus.108216)
  • [L2] Although most of the studies reported an association between GLP-1 RA and increased residual gastric contents, evidence linking these medications to a statistically significant rise in regurgitation or aspiration events remains highly inconsistent. (10.1186/s13741-026-00662-9)

References

[1] GLP-1 Agonists in Orthopedic Surgery: A Narrative Review of Bone Health and Surgical Implications. HSS Journal. 2026. DOI: 10.1177/15563316261438492

[2] GLP-1 receptor agonist therapy is not associated with adverse events following shoulder surgery: a systematic review and meta-analysis. Journal of Shoulder and Elbow Surgery. 2026. DOI: 10.1016/j.jse.2025.12.005

[3] The Impact of Glucagon-Like Peptide-1 Agonists on Hip and Knee Arthroplasty and Perioperative Considerations. The Journal of Arthroplasty. 2024. DOI: 10.1016/j.arth.2023.12.002

[4] Glucagon-Like Peptide-1 Receptor Agonists: Have We Found the Holy Grail for Total Joint Arthroplasty?. The Journal of Arthroplasty. 2025. DOI: 10.1016/j.arth.2025.10.027

[5] GLP-1 Receptor Agonists in Orthopaedic Surgery: Implications for Perioperative Care and Outcomes. Journal of Bone and Joint Surgery. 2025. DOI: 10.2106/jbjs.24.01287

[6] Glucagon-Like Peptide-1 Receptor Agonists, Readmission, and Postoperative Complications in Arthroplasty: A Systematic Review and Meta-Analysis. The Journal of Arthroplasty. 2025. DOI: 10.1016/j.arth.2025.11.036

[7] 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. The Journal of Arthroplasty. 2025. DOI: 10.1016/j.arth.2025.09.054

[8] Glucagon-like peptide-1 receptor agonists in total joint arthroplasty: a comprehensive systematic review of what orthopaedic surgeons should know. Arthroplasty. 2026. DOI: 10.1186/s42836-026-00375-w

[9] GLP-1 agonists: a new hope for patients, a new challenge for anaesthetists. Anaesthesiology Intensive Therapy. 2025. DOI: 10.5114/ait/203167

[10] Periprocedural use of GLP-1 receptor agonists: ANZCA Clinical Practice Recommendations. ANZCA. 2025.

[11] Glucagon-like peptide-1 receptor agonists and fracture risk: a network meta-analysis of randomized clinical trials. Osteoporosis International. 2018. DOI: 10.1007/s00198-018-4649-8

[12] Delayed gastric emptying induced by glucagon-like peptide-1 receptor agonists and its implications for perioperative risk during anesthesia. The Korean Journal of Internal Medicine. 2026. DOI: 10.3904/kjim.2025.277

[13] Impact of Glucagon-Like Peptide-1 Receptor Agonists on Postoperative Outcomes in Arthroplasty: A Systematic Review. The Journal of Arthroplasty. 2025. DOI: 10.1016/j.arth.2025.07.015

[14] Semaglutide and Other GLP-1 Agonists: A Boon for the Arthroplasty Industry?. The Journal of Arthroplasty. 2024. DOI: 10.1016/j.arth.2023.12.014

[15] The Impact of Contemporary Glucagon-like Peptide-1 Receptor Agonists on the Onset, Severity, and Conversion to Arthroplasty in Hip and Knee Osteoarthritis. Orthopaedic Journal of Sports Medicine. 2025. DOI: 10.1177/23259671241297157

[16] Differential effects of GLP-1 receptor agonists on diabetic osteopathy in type 2 diabetes: a patient-stratified network meta-analysis. BMC Musculoskeletal Disorders. 2025. DOI: 10.1186/s12891-025-09022-y

[17] Impact of Perioperative Glucagon-Like Peptide-1 Receptor Agonists on Postoperative Outcomes Following Carpal Tunnel Release. Journal of Hand Surgery Global Online. 2025. DOI: 10.1016/j.jhsg.2025.100746

[18] The Association Between Glucagon-Like Peptide-1 Receptor Agonists and Postoperative Complications After Arthroplasty: A Systematic Review and Meta-Analysis. The Journal of Arthroplasty. 2025. DOI: 10.1016/j.arth.2025.06.083

[19] Peri-Procedural Fasting and Gastric Ultrasound Strategies in Glucagon-Like Peptide-1 (GLP-1) Receptor Agonist Users: A Systematic Review With Qualitative Synthesis. Cureus. 2026. DOI: 10.7759/cureus.108216

[20] Perioperative anesthesia management of GLP-1 receptor agonists: a systematic review of potential risks. Perioperative Medicine. 2026. DOI: 10.1186/s13741-026-00662-9

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