Preoperative Weight Loss Intervention With Glucagon-Like Peptides 1 Receptor Agonists Is Associated With Lower Complication Rates Following Primary Total Knee Arthroplasty Than Preoperative Bariatric Surgery

Background: Obesity is a risk factor for adverse outcomes following total knee arthroplasty (TKA). Bariatric surgery (BS) and glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are weight-loss strategies commonly encountered in TKA patients. This study aimed to compare short- and long-term complications among obese patients treated with either BS or GLP-1 RAs prior to TKA. Methods: The database was queried to identify patients with obesity (body mass index [BMI] ≥35 kg/m2) undergoing primary TKA. Patients were stratified based on interventions within 1 year prior to surgery: BS, GLP-1 RA, and no weight-loss intervention. Propensity score matching was performed to balance baseline characteristics. Subgroup analyses were conducted for BMI 35–40 kg/m² and >40 kg/m². Primary outcomes included periprosthetic joint infection (PJI), aseptic loosening, periprosthetic fracture, and revision surgery at 90 days, 2 years, and 5 years. Results: In the matched BMI ≥35 kg/m² cohort (n = 3635 per group), patients with prior BS had significantly higher odds of all surgical complications, including PJI (odds ratio [OR]: 1.70) and all-cause revision (OR: 1.69) compared to the GLP-1 RA cohort. Compared to the no-intervention cohort, BS was associated with increased risks of PJI (OR: 1.33) and periprosthetic fracture (OR: 2.01). Conversely, the GLP-1 RA cohort showed significantly lower risks of surgical complications compared to the no-intervention cohort across most time points and BMI subgroups. Conclusions: Preoperative GLP-1 RA use is associated with lower complication rates than BS and demonstrates a protective safety profile compared with no weight-loss intervention, underscoring their potential role in preoperative obesity patients undergoing TKA.