Weight loss with GLP-1 receptor agonists before THA may increase mortality risk
Key takeaways:
- Weight loss with GLP-1s before total hip arthroplasty may decrease complications.
- However, these medications may increase mortality risk.
SAN DIEGO — Results presented here showed patients who had significant weight loss prior to total hip arthroplasty with use of a GLP-1 receptor agonist experienced a decreased risk for complications but an increased risk for mortality.
“It was important for us to understand medically [that] just because these patients are now under a weight threshold does not mean that they are safe for surgery,” Vishal Hegde, MD, FAAOS, associate professor at Johns Hopkins University, told Healio about results presented at the American Academy of Orthopaedic Surgeons Annual Meeting. “We know that there are data that people who lose weight rapidly end up having worse complications than they would have if they had not lost weight rapidly. It was important for us to figure out what happens with these patients. Is there a decreased risk in complications or is there something hidden that we did not realize is there that we need to study more with these medications?”
Using the TriNetX research network, Hegde and colleagues categorized patients undergoing primary THA based on whether they received a GLP-1 prescription and had a preoperative decrease in BMI from 43 kg/m2 or greater to 40 kg/m2 or less within a year prior to surgery, had a BMI of 43 kg/m2 or greater but did not receive a GLP-1 prescription prior to surgery, or had a BMI of 40 kg/m2 or less and did not receive a GLP-1 prescription prior to surgery.
“Patients were one-to-one propensity score matched based on demographics, and baseline comorbidities, including diabetes, and complications within 1 year of surgery were examined,” Hegde said in his presentation.
Patients who were prescribed GLP-1s prior to THA had a decreased risk for pulmonary embolism compared with patients with a BMI of greater than 43 kg/m2, according to Hegde. However, he said patients who were prescribed GLP-1s had an increased risk for mortality.
When compared with patients who had a BMI of less than 40 kg/m2, Hegde said patients who were prescribed GLP-1s had a decreased risk for aspiration, but an increased risk for mortality.
“The results put up a little bit of a red flag and indicate that we probably need to study this a little bit more closely with more traditional randomized controlled trials,” Hegde told Healio. “This is a database study. It is a hypothesis-generating study and now that we have flagged this as a potential issue, it is up to us to look into this further and do more specific targeted research to better understand if this mortality risk if real or just noise that we picked up.”
Vishal Hegde, MD, FAAOS, from Johns Hopkins University, can be reached at vhegde2@jhmi.edu.
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Buddhiraju A, et al. Paper 348. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; March 10-14, 2025; San Diego.