GLP‐1 receptor agonists in hip, knee and shoulder arthroplasty: Implications for obesity, osteoarthritis, metabolic optimisation and complications

Glucagon-like peptide-1 receptor agonists and related incretin-based therapies are rapidly changing the management of obesity and metabolic disease. Their increasing use also among patients with osteoarthritis has important implications for hip, knee and shoulder arthroplasty. Beyond weight loss, these drugs may influence systemic inflammation, glycemic control, osteoarthritic symptoms, perioperative complications and surgical candidacy. Recent retrospective studies suggest that preoperative GLP-1 receptor agonist use may be associated with lower risks of periprosthetic joint infection, hospital readmission and other adverse outcomes after total joint arthroplasty. Beyond the perioperative setting, GLP-1 receptor agonists have also been associated with reductions in blood pressure and significant improvements in cardiovascular risk among patients with chronic kidney disease or preexisting cardiovascular disease. However, the current evidence remains largely observational and is limited by residual confounding, indication bias, heterogeneity in treatment timing, and inconsistent reporting of drug class, dose, and duration. This editorial argues that GLP-1 receptor agonists should not be viewed simply as weight-loss agents before arthroplasty, but as part of a broader movement toward metabolic optimisation. Prospective studies are needed before these therapies can be incorporated into standardised arthroplasty optimisation pathways.