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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.

21 citationsUpdated Sep 2026

For patients: a plain-language version of this topic is available. See the patient guide.

Overview

Arthroplasty surgeons will encounter an increasing number of patients on GLP-1 receptor agonists (GLP-1RAs), making it critical to understand the implications of their use in the perioperative period [4]. These agents are a promising tool for preoperative weight loss in patients with obesity and type-2 diabetes mellitus undergoing orthopaedic surgery [6]. By enabling weight loss and improving diabetic control, semaglutide and other GLP-1 agonists may increase the number of eligible candidates for elective total joint arthroplasty [12]. However, GLP-1 agonists may not produce sufficient weight loss to achieve body mass index cutoffs for total joint arthroplasty depending on individual patient factors, including starting bodyweight [2].

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 [14]. 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 periprosthetic joint infection [16]. Furthermore, GLP-1 RA use was associated with improved early surgical outcomes and decreased resource utilization following total hip and total knee arthroplasty [8]. 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 [7].

Despite these signals, findings remain inconsistent, and conflicting results highlight the need for further research to clarify the effects of GLP-1 RAs on surgical outcomes [5, 15]. 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 [18]. Due to the increasing popularity of GLP-1RAs in patients with obesity, further high-quality studies are needed to address the optimal perioperative care of patients on GLP-1RAs [10].

Effects on Surgery and Recovery

Arthroplasty Outcomes and Complications

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 [14]. Conversely, this perioperative use may be associated with a reduced risk of postoperative infection [14]. Semaglutide and other GLP-1 agonists may potentially reduce postoperative complications such as sepsis and prosthetic joint infections [12]. However, while GLP-1 receptor agonists show potential to reduce postoperative complications in total joint arthroplasty, findings remain inconsistent [5].

Other Orthopaedic Procedures

In patients undergoing carpal tunnel release, perioperative GLP-1RA use was associated with a small yet statistically significant reduction in the odds of wound dehiscence [17]. This use did not increase the odds of any other 90-day postoperative complications following the procedure [17].

Perioperative Management and Anesthesia

Most studies report an association between GLP-1 RA and increased residual gastric contents [20]. Evidence linking GLP-1 RAs to a statistically significant rise in regurgitation or aspiration events remains highly inconsistent [20]. Available observational evidence suggests that the following interventions may be associated with reduced residual gastric content in selected patient populations: * Extended GLP-1 RA withholding * 24-hour clear liquid diets * Pre-procedural gastric POCUS

[21]. The authors call for further high-quality studies to address the optimal perioperative care of patients on GLP-1RAs [10]. Interdisciplinary collaboration between endocrinologists and anesthesiologists is emphasized to ensure safe and individualized perioperative management [11].

Preoperative Weight Loss and Eligibility

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 [12].

Practical Considerations

Perioperative Management and Anesthesia

GLP-1 RA-induced delayed gastric emptying necessitates interdisciplinary collaboration between endocrinologists and anesthesiologists to ensure safe and individualized perioperative management [11]. While most studies report an association between GLP-1 RA use and increased residual gastric contents, evidence linking these medications to a statistically significant rise in regurgitation or aspiration events remains highly inconsistent [20]. Further high-quality studies are required to address the optimal perioperative care of patients on GLP-1RAs [10].

Surgical Outcomes and Complications

Findings regarding the potential of GLP-1 receptor agonists to reduce postoperative complications in total joint arthroplasty remain inconsistent. Further research is needed to clarify their impact on outcomes and establish perioperative management guidelines [5].

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. [1] (10.1177/15563316261438492)
  • [Paper] While efficacious, GLP-1 agonists may not produce sufficient weight loss to achieve body mass index cutoffs for total joint arthroplasty depending on individual patient factors, including starting bodyweight. [2] (10.2106/jbjs.rvw.23.00167)
  • [L1] GLP-1 agonist use is not significantly associated with 90-day or 2-year adverse events following total shoulder arthroplasty. [3] (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. [4] (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. [5] (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. [6] (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. [7] (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. [8] (10.1016/j.arth.2025.09.054)
  • [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. [9] (10.1186/s12891-025-09022-y)
  • [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] (10.5114/ait/203167)
  • [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. [11] (10.3904/kjim.2025.277)
  • [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. [12] (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. [13] (10.1177/23259671241297157)
  • [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. [14] (10.1186/s42836-026-00375-w)
  • [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. [15] (10.1016/j.arth.2025.07.015)
  • [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. [16] (10.1016/j.arth.2025.06.083)
  • [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. [17] (10.1016/j.jhsg.2025.100746)
  • [L1] Exenatide is the best option agent with regard to the risk of fracture. [19] (10.1007/s00198-018-4649-8)
  • [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. [20] (10.1186/s13741-026-00662-9)
  • [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. [21] (10.7759/cureus.108216)

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] Glucagon-like Peptide-1 Agonists. JBJS Reviews. 2024. DOI: 10.2106/jbjs.rvw.23.00167

[3] 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

[4] 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

[5] 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

[6] 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

[7] 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

[8] 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

[9] 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

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

[11] 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

[12] 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

[13] 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

[14] 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

[15] 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

[16] 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

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

[19] 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

[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

[21] 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

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