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Mga Gamot na GLP-1 (Ozempic, Wegovy) at ang Iyong Operasyon

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If you take a GLP-1 medication (such as semaglutide — Ozempic or Wegovy) and you are having an operation: what these drugs do, why they matter for your anaesthetic (delayed stomach emptying and aspiration risk), and what you should do before surgery.

Updated Jul 2026
Isang medikal na injection pen.
Ang mga gamot na GLP-1 ay lumalawak ang paggamit at may mga implikasyong dapat talakayin bago ang operasyon at anestesia. Kieran Hirpara 4.0

Ang pahinang ito ay isinalin ng makina at hindi pa nasusuri ng isang doktor. Ang bersyong Ingles ang siyang opisyal.

Ano ang nararamdaman mo

Maaaring mapansin mong iba ang pakiramdam ng iyong katawan habang naghahanda ka para sa operasyon. Maraming pasyente ang nakakakita na nakakatulong ang mga gamot na GLP-1 sa pagbaba ng timbang bago ang prosedura. Maaari nitong gawing mas madali ang operasyon at mas maayos ang paggaling. Maaaring maramdaman mo ang mas maraming enerhiya habang bumababa ang iyong timbang. Gayunpaman, binabago ng mga gamot na ito ang paraan ng paggana ng iyong tiyan. Pinapabagal nito ang pagtunaw ng pagkain. Ibig sabihin, mas matagal nananatili ang pagkain sa iyong tiyan kaysa sa karaniwan.

Dahil sa mas mabagal na pagtunaw, maaaring maramdaman mong puno ka agad pagkatapos kumain ng kaunting dami. Maaari kang maranasan ang pagsusuka o pakiramdam ng bigat sa iyong tiyan. May mga taong nakakakita ng heartburn o acid reflux. Karaniwang sintomas ito kapag nagsisimula ka sa gamot o pinapataas ang dose. Madalas itong mangyari pagkatapos ng pagkain. Maaaring maramdaman mo ang hindi komportable kung kumain ka nang mabilis o pumili ng mabigat at mapanlik na pagkain.

Gabayin ka ng iyong doktor kung dapat itigil ang mga gamot na ito bago ang operasyon. Ang kasalukuyang ebidensya ay hindi nagrekomenda ng pagtitigil nito nang maaga dahil maaari nitong sanhi ang pagtaas ng asukal sa dugo at pagbalik ng timbang. Sa halip, pamamahalaan ng iyong koponan ng kalusugan ang oras nang maingat. Tinutulungan nito ang pagpapanatili ng stable na timbang at kontrolado na asukal sa dugo habang nagaganap ang proseso ng paggaling.

Pagkatapos ng operasyon, maaaring magtanong ka kung paano nakakaapekto ang mga gamot na ito sa iyong paggaling. Ipakita ng pananaliksik na ang paggamit ng mga gamot na GLP-1 sa paligid ng oras ng pagpapalit ng kasukasuan ay hindi nagpapataas ng panganib ng komplikasyon sa unang 90 araw o dalawang taon. Sa katunayan, may ilang pag-aaral ang nagmumungkahi ng mas mababang panganib ng impeksyon at pagbabalik sa ospital. Maaaring gumaling ka nang mas mabilis at gumamit ng mas kaunting mga mapagkukunan sa ospital.

Gayunpaman, maaaring makaapekto ang mga gamot na ito sa kalusugan ng buto. May ilang uri na maaaring magpalakas ng panganib ng mga pagkabali. Ang Exenatide ay itinuturing na pinakaligtas na opsyon para sa lakas ng buto sa mga gamot na ito. Babantayan ng iyong doktor ang iyong mga buto nang mahigpit. Kung mayroon kang osteoarthritis, o arthritis na dulot ng pagkasira, babantayan ng iyong doktor ang anumang pagbabago. Tinitiyak nito na mananatiling malakas ang iyong mga kasukasuan habang binabawi mo ang galaw.

Maaaring maramdaman mo ang pag-aalala tungkol sa mga pagbabagong ito. Normal na mag-alala kung paano nakikipag-interaksyon ang mga gamot sa operasyon. Tandaan na may karanasan ang iyong koponan sa ganitong sitwasyon. Isasapuso nila ang plano sa iyong katawan. Tumutok sa pagsunod sa kanilang mga tagubilin sa pagkain at oras ng pag-inom ng gamot. Tinutulungan nito ang pagpapanatili ng iyong kaligtasan at kaginhawaan sa buong iyong paglalakbay.

Ano ang nangyayari talaga

Ginagamit ng iyong katawan ang mga gamot na ito upang matulungan ang pagmamana ng timbang at asukal sa dugo. Gumagana ang mga ito sa pamamagitan ng pagpapabagal ng bilis ng pagdidilig ng pagkain sa iyong tiyan. Pinapanatili nito ang pakiramdam ng pagkabusog nang mas matagal at tumutulong sa iyong katawan na mas mahusay na hawakan ang glucose. Para sa maraming pasyente, ito ay isang makabuluhang kasangkapan bago ang operasyon. Maaari itong magdulot ng mas magandang maagang resulta pagkatapos ng pagpapalit ng kasu-kasuan at maaaring bawasan ang panganib ng pagkakaroon ng kailangan na bumalik sa ospital.

Gayunpaman, ang mas mabagal na pagtunaw ay nagbabago sa paraan ng paghawak ng iyong katawan sa anestesia at paggaling. Dahil nananatili ang pagkain sa iyong tiyan nang mas matagal, may mas mataas na panganib na lumabas ang nilalaman ng tiyan habang nasa operasyon. Ito ang dahilan kung bakit kailangan mong ipaalam sa iyong doktor na sinusubukan ang mga gamot na ito. Pinapayagan nito silang magplano ng iyong pag-aalaga nang ligtas. Hindi inirerekomenda ang pagtigil sa gamot nang sarili mong desisyon. Ang paggawa nito ay maaaring magdulot ng pagtaas ng iyong asukal sa dugo at gawing mas mahirap ang pagmamana ng iyong timbang.

Ang mga gamot na ito ay may interaksyon din sa iyong mga buto at kasu-kasuan sa mga kumplikadong paraan. Maaari silang mag-alok ng ilang proteksyon laban sa pagkawala ng buto sa ilang mga pasyente na may diyabetes. Gayunpaman, ang mga epekto sa pangmatagalang kalusugan ng kasu-kasuan ay patuloy na pinag-aaralan. May ilang datos na nagmumungkahi na maaari nilang bawasan ang panganib ng impeksyon pagkatapos ng operasyon sa balikat o tuhod. Ang ibang mga natuklasan ay halo-halo. Timbangin ng iyong doktor ang mga benepisyo na ito laban sa mga panganib. Gusto nilang siguraduhing ang iyong mga buto at kasu-kasuan ay kasing lakas ng posibleng para sa iyong prosedura.

Ang layunin ay panatilihin ang iyong katatagan. Hindi mo dapat tigilin ang pag-inom ng iyong inirekomendang dosis bago ang operasyon maliban na lamang kung ang iyong doktor ang nagsasabi sa iyo. Biglaang mga pagbabago ay maaaring makasama sa iyong kalusugan higit pa sa operasyon mismo. Gabayan ka ng iyong medical team sa pinakamahusay na oras. Tinitiyak nito na makakuha ka ng mga benepisyo sa timbang at asukal nang hindi pinapataas ang iyong surgical risk.

Ano ang inaasahan

Maaaring mapansin mo ang mga pagbabago sa iyong katawan habang naghahanda para sa operasyon. Ang mga gamot na GLP-1 ay tumutulong sa pagbaba ng timbang at kontrol sa asukal sa dugo. Ang mga tool na ito ay maaaring mapabuti ang maagang paggaling pagkatapos ng joint replacement. Maaaring makaranas ka ng mas kaunting bisita sa ospital at mas kaunting stress sa mga yaman ng kalusugan. May ilang datos din na nag-uugnay sa mga gamot na ito sa mas mababang panganib ng impeksyon pagkatapos ng operasyon sa balikat o tuhod.

Maaaring panatilihin ng iyong doktor ang paggamit ng iyong mga gamot. Hindi inirerekomenda ang pagtigil sa gamot bago ang operasyon. Wala pang sapat na ebidensya na nakakatulong ang pagtigil. Sa halip, maaari itong magdulot ng mataas na antas ng asukal sa dugo at pagtaas ng timbang. Ginagawa nitong mas mahirap ang pamamahala ng iyong kalusugan. Gusto ng iyong koponan ng kalusugan na panatilihing stable ang iyong timbang at antas ng asukal sa dugo.

Dapat mong malaman na hindi laging pare-pareho ang resulta para sa lahat. Patuloy pa ring lumalago ang pananaliksik tungkol sa mga gamot na ito. Habang maraming pasyente ang magagaling, may ilang pag-aaral na nagpapakita ng halo-halong resulta. Kailangan pa natin ng mas maraming mataas na kalidad na pag-aaral upang lubos na maunawaan ang pinakamainam na paraan ng paggamit ng mga gamot na ito sa paligid ng operasyon.

Ang kalusugan ng buto ay isa pang bahagi ng larawan. Ang mga gamot na ito ay nakakaapekto sa paraan ng paghawak ng iyong katawan sa buto. Ang Exenatide ay maaaring magdala ng mas mababang panganib ng fracture kumpara sa ibang mga opsyon sa parehong klase. Mayroon ding patuloy na imbestigasyon kung ang mga gamot na ito ay may ugnayan sa mga bagong kaso ng wear-and-tear arthritis. Ito ay isang kumplikadong larangan na mahigpit na maa-monitor ng iyong doktor.

Sa kabuuan, ang pananaw ay karaniwang positibo para sa mga nagpamamahala ng timbang at diabetes gamit ang mga tool na ito. Malamang na magkakaroon ka ng mas maayos na daan sa iyong prosedura. Maaaring harapin mo ang mas kaunting komplikasyon at mas mabilis na pagbabalik sa pang-araw-araw na buhay. Ii-customize ng iyong doktor ang plano ayon sa iyong tiyak na pangangailangan. Manatili sa iyong mga gamot ayon sa utos. Ipabatid sa iyong koponan ng kalusugan ang anumang pagbabago. Ang paraang ito ay sumusuporta sa pinakamainam na posibleng resulta para sa iyong operasyon.

Reviewed by Kieran Hirpara · 13 June 2026.

Want the clinical detail? Read the clinician version.

Talk to your treating clinician for advice specific to you.

For an appointment with the CQ Hand + Upper Limb team, ask your GP about a referral or visit www.cqupperlimb.com.

Evidence & references

This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.

Overview

  • GLP-1 receptor agonists induce delayed gastric emptying, which has implications for perioperative aspiration risk during anesthesia [1].
  • The increasing prevalence of GLP-1 receptor agonist use in patients with obesity presents a new challenge for anesthesiologists [2].
  • High-quality studies are needed to determine optimal perioperative care for patients on GLP-1 receptor agonists [2].
  • GLP-1 receptor agonists show potential to reduce postoperative complications in total joint arthroplasty, but findings remain inconsistent [3].
  • Further research is needed to clarify the impact of GLP-1 receptor agonists on surgical outcomes and establish perioperative management guidelines [3].
  • Conflicting findings regarding the impact of GLP-1 receptor agonists on postoperative outcomes in arthroplasty highlight the need for well-designed multicenter studies and randomized controlled trials [4].
  • Arthroplasty surgeons will encounter an increasing number of patients on GLP-1 agonists, necessitating an understanding of their perioperative implications [5].
  • GLP-1 receptor agonist therapy is not associated with adverse events following shoulder surgery [6].
  • GLP-1 agonist use should not be a contraindication for proceeding with total shoulder arthroplasty [6].
  • Elective preprocedural cessation of GLP-1 receptor agonists and GLP-1/GIP receptor agonists is not recommended due to insufficient data supporting cessation and risks of hyperglycemia and compromised weight control [7].
  • Variability in available studies, potential confounding factors, and severe heterogeneity of conclusions emphasize the need for more high-quality evidence-based primary research to optimize perioperative management of patients taking GLP-1 receptor agonists [8].
  • Narrative reviews explore the mechanisms of action of GLP-1 agonists, their effects on bone health, and their implications in perioperative patients undergoing orthopedic surgery, with an emphasis on spine surgery [9].
  • 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 [10].
  • Semaglutide and other GLP-1 agonists may potentially reduce postoperative complications such as sepsis and prosthetic joint infections [10].
  • GLP-1 receptor agonist use suggests a potential benefit for optimizing high-risk patients with obesity or diabetes undergoing total joint arthroplasty [11].
  • GLP-1 receptor agonists may provide skeletal benefits in type 2 diabetes patients by addressing specific mechanisms underlying diabetic osteopathy [16].
  • The effects of GLP-1 receptor agonists on diabetic osteopathy vary by agent type, patient characteristics, and treatment duration [16].
  • Further investigation is needed to elucidate the association between GLP-1 receptor agonist use and the increased incidence of osteoarthritis diagnosis and conversion to total knee arthroplasty in patients with no preexisting osteoarthritis [19].

Effects on Surgery and Recovery

  • Interdisciplinary collaboration between endocrinologists and anesthesiologists is important to ensure safe and individualized perioperative management of patients on GLP-1 RAs [1].
  • High-quality studies are needed to address the optimal perioperative care of patients on GLP-1RAs [2].
  • Further research is needed to clarify the impact of GLP-1 receptor agonists on outcomes and establish perioperative management guidelines for total joint arthroplasty [3].
  • Conflicting findings regarding the effects of GLP-1 RAs on surgical outcomes highlight the need for well-designed multicenter studies and randomized controlled trials [4].
  • GLP-1 agonist use should not be a contraindication for proceeding with total shoulder arthroplasty (TSA) [6].
  • Elective preprocedural cessation of GLP-1RAs and GLP-1/GIPRAs is not recommended due to insufficient data supporting cessation and risks of hyperglycemia and compromised weight control [7].
  • Variability in available studies, potential confounding factors, and severe heterogeneity of conclusions emphasize the need for more high-quality evidence-based primary research to optimize perioperative management of patients taking GLP-1 RAs [8].
  • Semaglutide and other GLP-1 agonists may reduce postoperative complications such as sepsis and prosthetic joint infections in total joint arthroplasty [10].
  • GLP-1RA use has a potential benefit for optimizing high-risk patients with obesity or diabetes undergoing total joint arthroplasty [11].
  • Preoperative glucagon-like peptide-1 receptor agonist use may be linked to reduced readmission risk following joint arthroplasty [12].
  • Preoperative glucagon-like peptide-1 receptor agonist use is not associated with evidence of increased postoperative medical harm following joint arthroplasty [12].
  • 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 [13].
  • Perioperative GLP-1 RA use in patients undergoing total hip or knee arthroplasty may be associated with a reduced risk of postoperative infection [13].
  • 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 [14].
  • Perioperative GLP-1RA use was associated with a small yet statistically significant reduction in the odds of wound dehiscence following carpal tunnel release (CTR) [15].
  • Perioperative GLP-1RA use did not increase the odds of any other 90-day postoperative complications following carpal tunnel release [15].
  • Exenatide is the best option agent with regard to the risk of fracture among GLP-1 receptor agonists [17].
  • GLP-1 receptor agonists are a promising tool for preoperative weight loss in patients with obesity and type-2 diabetes mellitus undergoing orthopaedic surgery [18].

Practical Considerations

  • The increasing prevalence of GLP-1 RA use in patients with obesity presents a new challenge for anesthesiologists regarding perioperative care [2].
  • High-quality studies are needed to address the optimal perioperative care of patients on GLP-1 RAs [2].
  • Further research is needed to clarify the impact of GLP-1 RAs on outcomes and establish perioperative management guidelines for total joint arthroplasty [3].
  • Conflicting findings regarding the effects of GLP-1 RAs on surgical outcomes highlight the need for further research, including well-designed multicenter studies and randomized controlled trials [4].
  • Elective preprocedural cessation of GLP-1 RAs and GLP-1/GIP RAs is not recommended due to insufficient data supporting cessation and the risks of hyperglycemia and compromised weight control [7].
  • Narrative reviews explore the mechanisms of action of GLP-1 agonists, their effects on bone health, and their implications for perioperative patients undergoing orthopedic surgery, with an emphasis on spine surgery [9].
  • GLP-1 RA use may benefit high-risk patients with obesity or diabetes undergoing total joint arthroplasty [11].
  • Preoperative GLP-1 receptor agonist use may be linked to reduced readmission risk following joint arthroplasty [12].
  • Preoperative GLP-1 receptor agonist use is not associated with evidence of increased postoperative medical harm in joint arthroplasty [12].

Key Evidence

  • [L4] This review summarizes the pharmacological mechanisms and clinical implications of GLP-1 RA-induced delayed gastric emptying, evaluates current literature on perioperative aspiration risk, and emphasizes the importance of interdisciplinary collaboration between endocrinologists and anesthesiologists to ensure safe and individualized perioperative management. [1] (10.3904/kjim.2025.277)
  • [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. [2] (10.5114/ait/203167)
  • [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. [3] (10.1016/j.arth.2025.10.027)
  • [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. [4] (10.1016/j.arth.2025.07.015)
  • [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. [5] (10.1016/j.arth.2023.12.002)
  • [L1] Based on this data, GLP-1 agonist use should not be a contraindication for proceeding with TSA. [6] (10.1016/j.jse.2025.12.005)
  • [L2] The variability in available studies, potential confounding factors, and the severe heterogeneity of conclusions all emphasize the need for more high-quality evidence-based primary research to optimize perioperative management of patients taking GLP-1 RAs. [8] (10.1186/s13741-026-00662-9)
  • [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. [9] (10.1177/15563316261438492)
  • [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] (10.1016/j.arth.2023.12.014)
  • [L1] These findings suggest a potential benefit of GLP-1RA use for optimizing high-risk patients who have obesity or diabetes undergoing total joint arthroplasty. [11] (10.1016/j.arth.2025.09.054)
  • [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. [12] (10.1016/j.arth.2025.11.036)
  • [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. [13] (10.1186/s42836-026-00375-w)
  • [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. [14] (10.7759/cureus.108216)
  • [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. [15] (10.1016/j.jhsg.2025.100746)
  • [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. [16] (10.1186/s12891-025-09022-y)
  • [L1] Exenatide is the best option agent with regard to the risk of fracture. [17] (10.1007/s00198-018-4649-8)
  • [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. [18] (10.2106/jbjs.24.01287)
  • [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. [19] (10.1177/23259671241297157)

References

[1] 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

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

[3] 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

[4] 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

[5] 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

[6] 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

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

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

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

[10] 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

[11] 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

[12] 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

[13] 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

[14] 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

[15] 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

[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] 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

[18] 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

[19] 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

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e. Exceptions and Limitations means fair use, fair dealing, and/or any other exception or limitation to Copyright and Similar Rights that applies to Your use of the Licensed Material.

f. Licensed Material means the artistic or literary work, database, or other material to which the Licensor applied this Public License.

g. Licensed Rights means the rights granted to You subject to the terms and conditions of this Public License, which are limited to all Copyright and Similar Rights that apply to Your use of the Licensed Material and that the Licensor has authority to license.

h. Licensor means the individual(s) or entity(ies) granting rights under this Public License.

i. NonCommercial means not primarily intended for or directed towards commercial advantage or monetary compensation. For purposes of this Public License, the exchange of the Licensed Material for other material subject to Copyright and Similar Rights by digital file-sharing or similar means is NonCommercial provided there is no payment of monetary compensation in connection with the exchange.

j. Share means to provide material to the public by any means or process that requires permission under the Licensed Rights, such as reproduction, public display, public performance, distribution, dissemination, communication, or importation, and to make material available to the public including in ways that members of the public may access the material from a place and at a time individually chosen by them.

k. Sui Generis Database Rights means rights other than copyright resulting from Directive 96/9/EC of the European Parliament and of the Council of 11 March 1996 on the legal protection of databases, as amended and/or succeeded, as well as other essentially equivalent rights anywhere in the world.

l. You means the individual or entity exercising the Licensed Rights under this Public License. Your has a corresponding meaning.

Section 2 -- Scope.

a. License grant.

1. Subject to the terms and conditions of this Public License, the Licensor hereby grants You a worldwide, royalty-free, non-sublicensable, non-exclusive, irrevocable license to exercise the Licensed Rights in the Licensed Material to:

a. reproduce and Share the Licensed Material, in whole or in part, for NonCommercial purposes only; and

b. produce, reproduce, and Share Adapted Material for NonCommercial purposes only.

2. Exceptions and Limitations. For the avoidance of doubt, where Exceptions and Limitations apply to Your use, this Public License does not apply, and You do not need to comply with its terms and conditions.

3. Term. The term of this Public License is specified in Section 6(a).

4. Media and formats; technical modifications allowed. The Licensor authorizes You to exercise the Licensed Rights in all media and formats whether now known or hereafter created, and to make technical modifications necessary to do so. The Licensor waives and/or agrees not to assert any right or authority to forbid You from making technical modifications necessary to exercise the Licensed Rights, including technical modifications necessary to circumvent Effective Technological Measures. For purposes of this Public License, simply making modifications authorized by this Section 2(a) (4) never produces Adapted Material.

5. Downstream recipients.

a. Offer from the Licensor -- Licensed Material. Every recipient of the Licensed Material automatically receives an offer from the Licensor to exercise the Licensed Rights under the terms and conditions of this Public License.

b. No downstream restrictions. You may not offer or impose any additional or different terms or conditions on, or apply any Effective Technological Measures to, the Licensed Material if doing so restricts exercise of the Licensed Rights by any recipient of the Licensed Material.

6. No endorsement. Nothing in this Public License constitutes or may be construed as permission to assert or imply that You are, or that Your use of the Licensed Material is, connected with, or sponsored, endorsed, or granted official status by, the Licensor or others designated to receive attribution as provided in Section 3(a)(1)(A)(i).

b. Other rights.

1. Moral rights, such as the right of integrity, are not licensed under this Public License, nor are publicity, privacy, and/or other similar personality rights; however, to the extent possible, the Licensor waives and/or agrees not to assert any such rights held by the Licensor to the limited extent necessary to allow You to exercise the Licensed Rights, but not otherwise.

2. Patent and trademark rights are not licensed under this Public License.

3. To the extent possible, the Licensor waives any right to collect royalties from You for the exercise of the Licensed Rights, whether directly or through a collecting society under any voluntary or waivable statutory or compulsory licensing scheme. In all other cases the Licensor expressly reserves any right to collect such royalties, including when the Licensed Material is used other than for NonCommercial purposes.

Section 3 -- License Conditions.

Your exercise of the Licensed Rights is expressly made subject to the following conditions.

a. Attribution.

1. If You Share the Licensed Material (including in modified form), You must:

a. retain the following if it is supplied by the Licensor with the Licensed Material:

i. identification of the creator(s) of the Licensed Material and any others designated to receive attribution, in any reasonable manner requested by the Licensor (including by pseudonym if designated);

ii. a copyright notice;

iii. a notice that refers to this Public License;

iv. a notice that refers to the disclaimer of warranties;

v. a URI or hyperlink to the Licensed Material to the extent reasonably practicable;

b. indicate if You modified the Licensed Material and retain an indication of any previous modifications; and

c. indicate the Licensed Material is licensed under this Public License, and include the text of, or the URI or hyperlink to, this Public License.

2. You may satisfy the conditions in Section 3(a)(1) in any reasonable manner based on the medium, means, and context in which You Share the Licensed Material. For example, it may be reasonable to satisfy the conditions by providing a URI or hyperlink to a resource that includes the required information.

3. If requested by the Licensor, You must remove any of the information required by Section 3(a)(1)(A) to the extent reasonably practicable.

4. If You Share Adapted Material You produce, the Adapter's License You apply must not prevent recipients of the Adapted Material from complying with this Public License.

Section 4 -- Sui Generis Database Rights.

Where the Licensed Rights include Sui Generis Database Rights that apply to Your use of the Licensed Material:

a. for the avoidance of doubt, Section 2(a)(1) grants You the right to extract, reuse, reproduce, and Share all or a substantial portion of the contents of the database for NonCommercial purposes only;

b. if You include all or a substantial portion of the database contents in a database in which You have Sui Generis Database Rights, then the database in which You have Sui Generis Database Rights (but not its individual contents) is Adapted Material; and

c. You must comply with the conditions in Section 3(a) if You Share all or a substantial portion of the contents of the database.

For the avoidance of doubt, this Section 4 supplements and does not replace Your obligations under this Public License where the Licensed Rights include other Copyright and Similar Rights.

Section 5 -- Disclaimer of Warranties and Limitation of Liability.

a. UNLESS OTHERWISE SEPARATELY UNDERTAKEN BY THE LICENSOR, TO THE EXTENT POSSIBLE, THE LICENSOR OFFERS THE LICENSED MATERIAL AS-IS AND AS-AVAILABLE, AND MAKES NO REPRESENTATIONS OR WARRANTIES OF ANY KIND CONCERNING THE LICENSED MATERIAL, WHETHER EXPRESS, IMPLIED, STATUTORY, OR OTHER. THIS INCLUDES, WITHOUT LIMITATION, WARRANTIES OF TITLE, MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, NON-INFRINGEMENT, ABSENCE OF LATENT OR OTHER DEFECTS, ACCURACY, OR THE PRESENCE OR ABSENCE OF ERRORS, WHETHER OR NOT KNOWN OR DISCOVERABLE. WHERE DISCLAIMERS OF WARRANTIES ARE NOT ALLOWED IN FULL OR IN PART, THIS DISCLAIMER MAY NOT APPLY TO YOU.

b. TO THE EXTENT POSSIBLE, IN NO EVENT WILL THE LICENSOR BE LIABLE TO YOU ON ANY LEGAL THEORY (INCLUDING, WITHOUT LIMITATION, NEGLIGENCE) OR OTHERWISE FOR ANY DIRECT, SPECIAL, INDIRECT, INCIDENTAL, CONSEQUENTIAL, PUNITIVE, EXEMPLARY, OR OTHER LOSSES, COSTS, EXPENSES, OR DAMAGES ARISING OUT OF THIS PUBLIC LICENSE OR USE OF THE LICENSED MATERIAL, EVEN IF THE LICENSOR HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH LOSSES, COSTS, EXPENSES, OR DAMAGES. WHERE A LIMITATION OF LIABILITY IS NOT ALLOWED IN FULL OR IN PART, THIS LIMITATION MAY NOT APPLY TO YOU.

c. The disclaimer of warranties and limitation of liability provided above shall be interpreted in a manner that, to the extent possible, most closely approximates an absolute disclaimer and waiver of all liability.

Section 6 -- Term and Termination.

a. This Public License applies for the term of the Copyright and Similar Rights licensed here. However, if You fail to comply with this Public License, then Your rights under this Public License terminate automatically.

b. Where Your right to use the Licensed Material has terminated under Section 6(a), it reinstates:

1. automatically as of the date the violation is cured, provided it is cured within 30 days of Your discovery of the violation; or

2. upon express reinstatement by the Licensor.

For the avoidance of doubt, this Section 6(b) does not affect any right the Licensor may have to seek remedies for Your violations of this Public License.

c. For the avoidance of doubt, the Licensor may also offer the Licensed Material under separate terms or conditions or stop distributing the Licensed Material at any time; however, doing so will not terminate this Public License.

d. Sections 1, 5, 6, 7, and 8 survive termination of this Public License.

Section 7 -- Other Terms and Conditions.

a. The Licensor shall not be bound by any additional or different terms or conditions communicated by You unless expressly agreed.

b. Any arrangements, understandings, or agreements regarding the Licensed Material not stated herein are separate from and independent of the terms and conditions of this Public License.

Section 8 -- Interpretation.

a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.

Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

Creative Commons may be contacted at creativecommons.org.