The Effects of Glucagon-Like Peptide-1 Agonist Therapy on Risk of Infection, Fracture, and Early Revision in Primary Total Joint Arthroplasty

Introduction:The purpose of this study was to examine rates of infection, revision, and periprosthetic fracture following total joint arthroplasty in diabetic patients treated with and without glucagon-like peptide-1 (GLP-1) agonist therapy.MethodsThe TriNetX Global Collaborative Network was queried for patients with diabetes mellitus undergoing primary total hip arthroplasty (THA) and total knee arthroplasty (TKA) from 2005 to 2024. Patients taking GLP-1 agonists within 1 year of surgery were matched to patients without. Cohort matching was done according to race, sex, body mass index nicotine dependence, hemoglobin A1c, and estimated glomerular filtration rate A total of 9,400 TKA procedures and 4,488 THA procedures constituted evenly divided cohorts. Outcomes included infection, revision surgery, and periprosthetic fractures at 3 months and 1 year. Bonferroni correction applied with threshold P < 0.0041.Results:TKA: periprosthetic infection following TKA was lower in the GLP-1 group compared with the non-GLP-1 group at both 3 months (0.94% vs. 1.45%; P < 0.001) and 1-year (1.21% vs. 2.04%; P < 0.001). Rates of periprosthetic fracture following TKA were higher albeit not markedly in patients prescribed GLP-1 agonists versus patients not receiving GLP-1 agonists at 3-months (0.47% vs. 0.21%; P = 0.034, respectively) and at 1-year (0.70% vs. 0.34%; P = 0.015) postoperatively. THA: No notable differences were observed in rates of infection, revision, or periprosthetic fracture in patients undergoing THA between those prescribed GLP-1s versus patients not receiving GLP-1 agonists at 3-months and 1-year.Conclusion:In this retrospective study of both TKA and THA among diabetic patients, we found that patients using GLP-1 agonists had a lower rate of periprosthetic infection following TKA. The benefits of GLP-1 therapy might limit infection risk, however additional research is needed to understand the effect these medications make on patient nutrition and bone metabolism.