Preoperative GLP-1 receptor agonist use and outcomes after total hip arthroplasty: a matched cohort study.

Abstract

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are increasingly prescribed among total hip arthroplasty (THA) candidates, yet their perioperative impact remains unclear. Using TriNetX, we identified adults undergoing primary THA (2003-2023) with preoperative GLP-1 RA exposure (⩾3 prescriptions within 1 year of surgery) versus controls. 1:1 propensity score matching for demographics, comorbidities, and baseline labs yielded 1262 patients per cohort. Outcomes included 90-day medical complications and mechanical complications (PJI, dislocation, aseptic loosening, periprosthetic fracture, all-cause revision) at 1, 2, and 5 years, reported in accordance with the STROBE guidelines. At 90 days, the GLP-1 RA cohort demonstrated significantly lower risks of DVT (1.6% vs. 3.0%; RR 0.53, 95% CI, 0.31-0.89; <i>p</i> = 0.014) and hospital readmission (1.1% vs. 2.8%; RR 0.40, 95% CI, 0.22-0.71; <i>p</i> = 0.001). No significant differences were found in other 90-day outcomes or in mechanical complications, including all-cause revision (94.6% vs. 95.5% survival; <i>p</i> = 0.674) and PJI (94.7% vs. 94.4%; <i>p</i> = 0.465) at 5 years. Consistent preoperative GLP-1 RA use is associated with reduced 90-day DVT and readmission following primary THA without increased risk of other complications or mechanical outcomes at 5 years. As DVT was the only significant thromboembolic endpoint, prospective investigation is needed before attributing a thromboprophylactic effect to these agents.