Glucagon-Like Peptide-1 Receptor Agonist Use Is Not Associated With Increased Complications After Total Hip Arthroplasty in Patients Who Have Type 2 Diabetes

Background: Glucagon-like peptide-1 (GLP-1) agonists have emerged as a powerful diabetic treatment adjunct; however, their effects on outcomes following total hip arthroplasty (THA) are not well known. This study aimed to compare the risk of complications in patients who had type 2 diabetes mellitus (DM) who were on GLP-1 agonists with those who were not on these medications.

Methods: In total, 14,065 patients who had type 2 DM undergoing primary THA between 2016 and 2021 were retrospectively reviewed using a national database. Propensity score matching was employed at a 1:4 ratio to match patients who used GLP-1 agonists (n = 812) to those who did not (n = 3,248). Patients were matched on age, sex, insulin status, presence of other diabetic medications, comorbidities, and smoking status. Multivariable logistic regressions were performed to examine 90-day and 1-year THA outcomes between groups.

Results: Patients who were not on GLP-1 agonists exhibited increased rates of extended hospital stays (≥3 days) (odds ratio 1.25, P = 0.01). Patients who were on GLP-1 agonists exhibited no significant differences in surgical or medical complication rates at 90 days compared to those not on GLP-1 agonists. There were also no significant differences in rates of all-cause revision THA, aseptic revision THA, or periprosthetic joint infection during the 1-year postoperative period.

Conclusions: This study demonstrated that GLP-1 agonists were not associated with increased risks for medical or surgical complications in patients who had DM undergoing THA and were associated with lower rates of extended hospital stays after surgery. This study provides additional evidence regarding the association of GLP-1 agonist use before THA with postoperative outcomes. Given the potential for increased glycemic control and weight loss, more data are needed to delineate the role of GLP-1 agonists in the optimization of patients who have DM before THA to minimize postoperative complications.

Level of evidence: Level III, retrospective cohort.