GLP-1 receptor agonists may improve outcomes for patients with morbid obesity after TKA
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Key takeaways:
- GLP-1s may be effective for weight optimization prior to knee arthroplasty in patients with morbid obesity.
- The medications may decrease the risk of complications.
Results showed patients with a BMI of 40 kg/m2 or more who used glucagon-like peptide-1 receptor agonists for at least 90 days before and after total knee arthroplasty had a decreased risk for postoperative complications vs. controls.
“It is important to stress that these preliminary results should be interpreted with caution. Association does not imply causation, and the mechanism of action of these agents on complication reduction remains unclear,” Gwo-Chin Lee, MD, hip and knee surgeon at Hospital for Special Surgery, told Healio. “Weight reduction, improved glycemic control or a combination of both may be at play. Additionally, due to the current cost and limited accessibility of these agents, patient socioeconomic factors may also contribute to these outcomes.”
Lee and colleagues performed a study of data from patients with morbid obesity (BMI of 40 kg/m2 or more) who underwent primary TKA between January 2010 and October 2022.
Lee and colleagues compared outcomes between two matched cohorts of patients who filled a prescription for a GLP-1 within at least 90 days before and after surgery and patients who did not use GLP-1s. Overall, 2,975 patients in each cohort were available at 90-day follow-up and 1,766 patients in each cohort were available at 2-year follow-up.
In addition, Lee and colleagues compared outcomes with a cohort of patients with severe obesity (BMI of 35 kg/m2 to 39.9 kg/m2). Among this cohort, 5,949 patients were available at 90-day follow-up and 3,530 patients were available at 2-year follow-up.
Among patients with morbid obesity, patients who were taking GLP-1s had a significant decrease in rates of periprosthetic joint infections (1% vs. 1.8%), medical complications (10.6% vs. 12.7%) and readmissions (5.3% vs. 8.9%) compared with patients who were not taking GLP-1s at 90 days. No differences were found in rates of surgical complications between these cohorts at 2-year follow-up.
Lee and colleagues also found patients with morbid obesity who were taking a GLP-1 had similar rates of infection and complications at 90 days and 2 years compared with patients with severe obesity.
“While these results are encouraging, randomized clinical trials are needed to determine the true impact of these agents in the preoperative optimization of patients undergoing total knee replacement surgery,” Lee said.
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