Preoperative use of GLP-1 receptor agonists — the drug class including semaglutide and liraglutide — is associated with reduced periprosthetic joint infection rates, lower hospital readmission, and fewer adverse outcomes following total joint arthroplasty, according to a synthesis of recent retrospective studies. The benefits extend beyond weight reduction to include systemic inflammation dampening, improved glycemic control, blood pressure reduction, and cardiovascular risk mitigation, particularly relevant in patients with chronic kidney disease or pre-existing cardiovascular disease.
The clinical significance here lies in reframing these drugs not as mere pre-surgical weight-loss tools but as metabolic optimization agents. Periprosthetic joint infection remains one of the most catastrophic and costly complications in orthopedic surgery, with infection rates in obese diabetic patients running two-to-four times higher than in metabolically healthy cohorts. If GLP-1 agonists genuinely reduce that risk through anti-inflammatory and glycemic pathways — independent of weight loss — that would represent a meaningful paradigm shift in surgical prehabilitation protocols.
However, the honest assessment here is cautious: all supporting evidence is observational, plagued by indication bias (healthier patients more likely prescribed these drugs), heterogeneous dosing regimens, and inconsistent drug-class reporting. Residual confounding is substantial. This editorial-style analysis contributes framing rather than novel data, making it confirmatory and hypothesis-generating rather than definitive. Randomized controlled trials examining standardized GLP-1 regimens against surgical outcomes are urgently needed before clinical protocols can responsibly incorporate these agents.