The Effect of Body Mass Index on the Efficacy of Semaglutide Use at the Time of Total Knee Arthroplasty.

Abstract

This study evaluated the impact of semaglutide on postoperative complications following total knee arthroplasty (TKA) by body mass index (BMI) class. A retrospective analysis of a national claims database was performed for patients undergoing primary TKA for osteoarthritis who had an active semaglutide prescription from January 2010 to April 2023. Patients were divided into non-obese (BMI < 30), obese (BMI 30.0 to 39.9), and morbidly obese (BMI > 40) groups. Semaglutide users were propensity score matched to non-users, yielding non-obese (7,402 versus 36,884), obese (4,034 versus 20,134), and morbidly obese (2,383 versus 11,853). Outcomes included 90-day medical complications, 90-day readmissions, and 90-day and 2-year implant-related complications. Univariate and multivariate regressions compared outcomes within BMI groups. In the non-obese group, semaglutide users had significantly lower odds of deep vein thrombosis (DVT) (odds ratio (OR) 0.68; 95% confidence interval (CI) 0.57 to 0.81; P < 0.001), pulmonary embolism (PE) (OR 0.49; 95% CI 0.34 to 0.70; P < 0.001), and pneumonia (PNA) (OR 0.69; 95% CI 0.53 to 0.89; P = 0.004). In obese patients, semaglutide users had significantly lower odds of 90-day periprosthetic joint infection (PJI) (OR 0.53; 95% CI 0.38 to 0.76; P < 0.001), 2-year PJI (OR 0.65; 95% CI 0.52 to 0.81; P < 0.001), 90-day revisions (OR 0.54; 95% CI 0.35 to 0.85; P = 0.008), DVT (OR 0.67; 95% CI 0.54 to 0.82; P < 0.001), pulmonary embolism (OR 0.39; 95% CI 0.23 to 0.62; P < 0.001), and PNA (OR 0.69; 95% CI 0.49 to 0.90; P = 0.008). In morbidly obese patients, semaglutide use was associated with significantly lower rates of 90-day aseptic loosening and myocardial infarction (both P < 0.001). Our findings support a BMI-based approach to perioperative semaglutide use, particularly in patients who have a BMI > 30.