Weight Loss in Primary Total Hip and Knee Arthroplasty: A Comparative Study of Glucagon-Like Peptide-1 Receptor Agonists and Bariatric Surgery

Background Our study evaluated 90-day outcomes of patients treated preoperatively with glucagon-like peptide-1 receptor agonists (GLP-1) or bariatric surgery compared to no weight loss intervention prior to total hip arthroplasty (THA) and total knee arthroplasty (TKA). Methods A multicenter institutional cohort of patients undergoing primary THA (n = 5710) and TKA (n = 6770) from 2023 to 2024 was identified. Preoperative weight-loss strategies included no intervention (89%), perioperative use of GLP-1 (10%), or prior bariatric surgery (1%). Ninety-day readmissions and reoperations were compared among groups. Subanalyses were performed stratifying obesity (body mass index) classification and diabetes mellitus status vs others to contextualize these independent risk factors. Results Among all patients undergoing THA and TKA, those who had undergone bariatric surgery experienced significantly higher reoperation rates at 90 days compared to those without intervention and GLP-1 groups (2.2 vs 0.5 vs 0.8%, respectively; P = .014). For THA, both the no intervention and GLP-1 groups had significantly lower readmission rates compared to the bariatric surgery group (4.4 vs 6.5 vs 8.8%, respectively; P = .04) and lower reoperation rates (0.4 vs 1.4 vs 2.2%; P = .006). For TKA, there were no significant differences in readmission ( P ≥ .47) or reoperation rates ( P ≥ .067) among the groups or by body mass index class and diabetes mellitus status. Conclusions Compared to no weight loss intervention, patients utilizing perioperative GLP-1s demonstrated similar 90-day readmission and reoperation rates after primary THA and TKA. Those with prior bariatric surgery showed the greatest risk of readmission and reoperation, particularly after THA. Level of Evidence IV, Retrospective Review.