Preoperative GLP-1 Receptor Agonist Use Improves Thromboembolic, Infectious, and Wound-Related Outcomes Following Unicompartmental Knee Arthroplasty
Zachary Fuller, Manjot Singh, Abhiram Dawar, Jeremiah Thomas, Alan H Daniels, Zuhdi E AbdoBackground
Glucagon-like peptide-1 (GLP-1) receptor agonists have demonstrated benefits in diabetes and obesity management, but their impact on outcomes following unicompartmental knee arthroplasty (UKA) remains unexplored. This study evaluates the influence of preoperative GLP-1 agonist use on postoperative complications following UKA.
Methods
A national claims database was queried to identify patients undergoing primary UKA between 2010 and 2021. Patients with preoperative GLP-1 prescriptions were 1:1 propensity-matched to non-users based on age, sex, Charlson Comorbidity Index, diabetes, obesity, and tobacco use, yielding two balanced cohorts of 1,138 patients each (mean age 61.1 years, 53% female). Successful matching was confirmed with standardized mean differences <0.001 for all variables. Primary outcomes included 90-day and 2-year complications. Categorical variables were compared using chi-square tests with relative risk reduction (RRR) and 95% confidence intervals.
Results
At 90 days, GLP-1 users demonstrated significantly lower rates of deep vein thrombosis (0.4% vs. 1.4%; RRR = 75%; 95% CI: 15-93%; P = 0.013), wound complications (0.0% vs. 1.2%; RRR = 100%; P < 0.001), and surgical site infections (0.1% vs. 1.2%; RRR = 93%; 95% CI: 34-99%; P = 0.002) compared to non-users. No significant differences were observed in pulmonary embolism, acute kidney injury, urinary tract infection, hematoma, transfusion requirements, or readmissions. At 2 years, GLP-1 users had significantly lower rates of prosthetic joint infection (0.4% vs. 1.4%; RRR = 75%; 95% CI: 15-93%; P = 0.013). All-cause revision rates showed a favorable trend in GLP-1 users but did not reach statistical significance (2.3% vs. 3.6%; RRR = 37%; P = 0.083).
Conclusion
Preoperative GLP-1 receptor agonist use was associated with lower rates of thromboembolic, infectious, and wound-related complications following UKA without an observed increase in other adverse events. These findings may reflect both medication-related effects and broader improvements in metabolic optimization. Prospective studies with detailed metabolic data are needed to further evaluate these associations.