Title: Institutional Trends in Glucagon-Like Peptide-1 Receptor Agonist Use Among Hip and Knee Arthroplasty Patients, 2021-2024

Juliet Rowe MPH¹, Maya Tailor BA¹, Alexandra Sideris PhD^1,2,3, Alex Illescas MPH¹, Jawad Saleh PharmD¹, Jashvant Poeran MD PhD^1,4, Daniel Maalouf MD MPH^1,2, Oliver Panzer MD^1,2

¹ Hospital for Special Surgery, Department of Anesthesiology, Critical Care & Pain Management, New York, NY, USA

² Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA

³ Hospital for Special Surgery Research Institute, Research Institute, New York, NY

⁴ Icahn School of Medicine at Mount Sinai, Institute for Healthcare Delivery Science, Department of Population Health Science and Policy, New York, NY, USA

Introduction

In recent years, the uptake of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) has increased substantially among adults in the United States. However, the prevalence of GLP-1 RA use among total hip and knee arthroplasty (TKA/THA) patients is not well characterized. We aimed to describe recent trends of GLP-1 RA usage among patients undergoing primary and revision THA and TKA at a high-volume orthopedic institution. 

 

Methods

This single-center retrospective cohort study was approved by our Institutional Review Board (IRB #2022-2392). All adult patients undergoing primary or revision THA or TKA between January 4, 2021 and December 31, 2024 were included in the analysis. GLP-1 RA usage was identified via electronic health record medication records, including type (dulaglutide, exenatide, liraglutide, semaglutide, lizisenatide, tirzepatide) and route of administration (oral, subcutaneous). Diabetes as an indication for GLP-1 RA use was identified using International Classification of Diseases, Tenth Revision (ICD-10) codes that were present on admission. Temporal trends of GLP-1 RA use were assessed using Cochran-Armitage trend tests, and associations with patient characteristics were assessed using standardized mean differences (SMD). Statistical significance was defined as p < 0.05, and SMDs greater than 0.1 indicated meaningful differences.

 

Results

Among a total of 45,537 included patients, GLP-1 RA use increased significantly from 2021 to 2024, rising from 3.69% in 2021 to 12.84% in 2024 (p < 0.0001, (Figure 1)). This upward trend was mainly driven by semaglutide and tirzepatide (Figure 2), which together accounted for 88.0% of all GLP-1 RA use in 2024. Conversely, use of liraglutide decreased significantly over the study period (p=0.004), while use of dulaglutide, exenatide, and lizisenatide remained unchanged (p=0.39, 0.60, 0.96, respectively) (Table 1). Subcutaneous administration remained the predominant route compared to oral (Table 1). Patient characteristics associated with GLP-1 RA use included ASA level, race, age, and BMI (Table 2). Specifically, there were higher rates of GLP-1 RA use among ASA 3 patients and Black patients, and GLP-1 RA users were younger and had higher BMIs, on average, compared to non-users. Additionally, there has been a significant decrease in the proportion of GLP-1 RA users with a documented diabetes diagnosis (Table 3), suggesting that a growing proportion are taking these drugs for non-diabetes indications.

 

Conclusion

At our high-volume orthopedic institution, GLP-1 RA use among TKA and THA patients has increased significantly from 2021 to 2024, with semaglutide and tirzepatide being the most common agents. These findings underscore the need to understand clinical implications of GLP-1 RAs as their use continues to grow in the surgical orthopedic population. Further investigation is needed to clarify how these medications may influence perioperative management considerations including fasting guidelines and anesthetic risk.