ArticleHSS journal : the musculoskeletal journal of Hospital for Special Surgery2026
GLP-1 Receptor Agonists Are Associated With Lower Early Revision Risk Compared to Bariatric Surgery Following Total Hip Arthroplasty: A Retrospective Cohort Study.
Article in HSS journal : the musculoskeletal journal of Hospital for Special Surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Obesity is a major modifiable risk factor in total hip arthroplasty (THA), associated with increased complications. While bariatric surgery has been the standard for massive weight loss, glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are increasingly used. Purposes: We sought to answer 2 questions: (1) Are early postoperative complication risks different between THA patients using GLP-1 RAs versus prior bariatric surgery? (2) Do differences persist at mid-term follow-up? Methods: We conducted a retrospective cohort study using the TriNetX Global Collaborative Network to identify adult patients (≥18 years) who underwent primary THA (current procedural terminology code 27130) between January 2015 and December 2025. Patients were divided into 2 cohorts: those with an active prescription for a GLP-1 RA (semaglutide, dulaglutide, liraglutide, tirzepatide, exenatide, albiglutide, or lixisenatide) within 18 months prior to the index THA procedure (N = 6877) or those with a history of bariatric surgery (sleeve gastrectomy, Roux-en-Y gastric bypass, adjustable gastric banding, and biliopancreatic diversion) within 18 months prior to the index THA procedure (N = 3960). Propensity-score matching (1:1) balanced cohorts on demographics and comorbidities. Outcomes included revision THA, dislocation/instability, PJI, wound complications, emergency department (ED) visits, and readmission at 1 to 90 days and 91 days to 1 year postoperatively. Results: Within 90 days, the GLP-1 RA cohort had lower risks of revision, PJI, ED visits, readmission, wound dehiscence, and dislocation. At mid-term follow-up, GLP-1 RA patients continued to show lower risks of PJI, readmission, and all-cause revision. Conclusion: Preoperative GLP-1 RA use was associated with lower early and mid-term complications compared to bariatric surgery, suggesting a potentially safer option for pre-THA weight optimization. Level of Evidence: Level III: retrospective cohort study.
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