GLP-1 Receptor Agonists Are Associated With Lower Early Revision Risk Compared to Bariatric Surgery Following Total Hip Arthroplasty: A Retrospective Cohort Study.
GLP-1 receptor agonists may be associated with lower early complications after total hip arthroplasty compared to bariatric surgery, but further research is needed to validate these findings.
Where it sits
this study against the rest of the albiglutide corpusSummary and findings
This study measured early postoperative complication risks in total hip arthroplasty (THA) patients using GLP-1 receptor agonists compared to those who underwent bariatric surgery. The study included 6,877 patients on GLP-1 RAs and 3,960 patients with a history of bariatric surgery. Results indicated lower risks of various complications in the GLP-1 RA cohort.
Abstract
<h4>Background</h4>Obesity is a major modifiable risk factor in total hip arthroplasty (THA), associated with increased complications. While bariatric surgery has been the standard for massive weight loss, glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are increasingly used.<h4>Purposes</h4>We sought to answer 2 questions: (1) Are early postoperative complication risks different between THA patients using GLP-1 RAs versus prior bariatric surgery? (2) Do differences persist at mid-term follow-up?<h4>Methods</h4>We conducted a retrospective cohort study using the TriNetX Global Collaborative Network to identify adult patients (≥18 years) who underwent primary THA (current procedural terminology code 27130) between January 2015 and December 2025. Patients were divided into 2 cohorts: those with an active prescription for a GLP-1 RA (semaglutide, dulaglutide, liraglutide, tirzepatide, exenatide, albiglutide, or lixisenatide) within 18 months prior to the index THA procedure (N = 6877) or those with a history of bariatric surgery (sleeve gastrectomy, Roux-en-Y gastric bypass, adjustable gastric banding, and biliopancreatic diversion) within 18 months prior to the index THA procedure (N = 3960). Propensity-score matching (1:1) balanced cohorts on demographics and comorbidities. Outcomes included revision THA, dislocation/instability, PJI, wound complications, emergency department (ED) visits, and readmission at 1 to 90 days and 91 days to 1 year postoperatively.<h4>Results</h4>Within 90 days, the GLP-1 RA cohort had lower risks of revision, PJI, ED visits, readmission, wound dehiscence, and dislocation. At mid-term follow-up, GLP-1 RA patients continued to show lower risks of PJI, readmission, and all-cause revision.<h4>Conclusion</h4>Preoperative GLP-1 RA use was associated with lower early and mid-term complications compared to bariatric surgery, suggesting a potentially safer option for pre-THA weight optimization.<h4>Level of evidence</h4>Level III: retrospective cohort study.
Background
This paper addresses the impact of obesity on complications following total hip arthroplasty (THA) and compares the use of GLP-1 receptor agonists to bariatric surgery for weight loss. Prior research has established that obesity increases the risk of complications in THA, and while bariatric surgery has been a standard intervention, GLP-1 receptor agonists are emerging as an alternative. Understanding the comparative risks associated with these interventions is crucial for optimizing patient outcomes.
Methods
The study utilized a retrospective cohort design, analyzing data from the TriNetX Global Collaborative Network. It included adult patients aged 18 years and older who underwent primary THA between January 2015 and December 2025. Patients were categorized into two groups: those with an active GLP-1 RA prescription (n=6877) and those with a history of bariatric surgery (n=3960), with propensity-score matching employed to balance demographics and comorbidities. Primary outcomes included revision THA, dislocation/instability, PJI, wound complications, ED visits, and readmission within specified postoperative timeframes.
Results
The GLP-1 RA cohort demonstrated lower risks of revision THA, PJI, ED visits, readmission, wound dehiscence, and dislocation within 90 days postoperatively. At mid-term follow-up, the GLP-1 RA group continued to show lower risks of PJI and readmission compared to the bariatric surgery cohort. Specific numeric findings were not reported in the abstract.
Interpretation
These findings suggest that preoperative use of GLP-1 receptor agonists may be associated with reduced early and mid-term complications compared to bariatric surgery. However, the clinical significance of these results should be interpreted cautiously, as the study's retrospective nature and potential biases limit the strength of the conclusions. The results may not be applicable to all patient populations, and further prospective studies are needed to validate these findings.
Key findings
- Lower risk of revision THA within 90 days in GLP-1 RA cohort compared to bariatric surgery cohort, n=6877 vs n=3960.
- Lower risk of PJI within 90 days in GLP-1 RA cohort, n=6877 vs n=3960.
- Lower risk of ED visits within 90 days in GLP-1 RA cohort, n=6877 vs n=3960.
- Lower risk of readmission within 90 days in GLP-1 RA cohort, n=6877 vs n=3960.
- Lower risk of wound dehiscence within 90 days in GLP-1 RA cohort, n=6877 vs n=3960.
- Lower risk of dislocation within 90 days in GLP-1 RA cohort, n=6877 vs n=3960.
Limitations
- Retrospective cohort study design.
- Potential biases from reliance on existing data.
- Findings may not be generalizable to all populations.
- No specific numeric outcomes reported in the abstract.