Preoperative Glucagon-Like Peptide-1 Agonist Use Is Associated With Decreased Complications Compared to Bariatric Surgery Following Primary Total Hip Arthroplasty

Background Obesity is a risk factor for adverse outcomes following total hip arthroplasty (THA). While weight loss strategies exist, the comparative impact of these approaches on surgical outcomes remains underexplored. This study aimed to compare complications among patients who had bariatric surgery versus prescription weight loss medications before THA. Methods A national database was queried to identify patients who have obesity (body mass index [BMI] > 35) undergoing primary THA. Patients were stratified into three cohorts based on interventions within 1 year before THA: (1) bariatric surgery, (2) glucagon-like peptide-1 receptor agonist (GLP-1 RA) prescription, and (3) no intervention. Propensity score matching was performed to balance baseline characteristics. In addition to the cohort analysis (BMI > 35), subgroup analyses were performed for patients who had a BMI of 35 to 40 and BMI > 40. Primary outcomes were periprosthetic joint infection (PJI), dislocation, aseptic loosening, and revision surgery at 90 days, two years, and five years. Results In the matched BMI greater than 35 cohort (n = 2,119 per group), patients who had prior bariatric surgery had higher odds of PJI (odds ratio [OR] 2.20, 95% confidence interval [CI] 1.62 to 3.00), dislocation (OR 2.03, 95% CI 1.31 to 3.14), and revision surgery (OR 2.75, 95% CI 1.79 to 4.24) at five years compared to the GLP-1 RA cohort. Compared to the no-intervention cohort, bariatric surgery was associated with increased PJI (OR 1.88) and revision (OR 1.71) risks. The GLP-1 RA cohort showed no significant differences in outcomes compared to the no intervention cohort across all time points and BMI subgroups. Conclusions Preoperative GLP-1 RA use is associated with lower complication risks compared to bariatric surgery and demonstrates a safety profile comparable to no weight loss intervention. These findings highlight potential influences of weight loss management strategies on longer term THA outcomes.