GLP-1 Receptor Agonists Show Promise for Pre-Total Knee Replacement Obesity Optimization, But Randomized Controlled Trials Are Critically Needed

Obesity is a major risk factor for poor outcomes in total knee replacement (TKR), leading to increased pain medication use, surgical site infections, and revision surgeries. Obese patients also experience more significant preoperative pain and lingering symptoms post-surgery. While general weight loss interventions before TKR have shown promise in retrospective studies for improving physical function, a significant research gap exists regarding randomized controlled trials (RCTs) on anti-obesity drugs. Specifically, the role of glucagon-like peptide-1 receptor agonists (GLP-1RAs) in perioperative optimization for TKR patients remains largely unexplored by robust clinical evidence.

This publication is a review examining the current landscape of weight loss interventions for obese patients undergoing total knee replacement (TKR). It synthesizes existing evidence, identifies critical research gaps, and highlights the potential role of glucagon-like peptide-1 receptor agonists (GLP-1RAs) in perioperative optimization. The authors did not conduct an experimental study but rather assessed the need for future randomized controlled trials (RCTs) to evaluate GLP-1RA efficacy and safety in this specific patient population, particularly noting the absence of such trials in Asian populations.

This review identified a critical research gap: there are currently no randomized controlled trials (RCTs) examining the effects of GLP-1RAs on knee arthroplasty outcomes, especially in Asian populations. Existing large database studies suggest GLP-1RAs may decrease the likelihood of certain post-surgery complications but also increase the risk of others. The authors noted that obese patients undergoing TKR face a higher risk of perioperative issues, including increased pain medication use, surgical site infections, and revision surgeries, compared to non-obese patients.

Retrospective studies have indicated that general weight loss interventions can improve physical function post-TKR, underscoring the potential benefit of effective anti-obesity strategies like GLP-1RAs. The review concludes that while GLP-1RAs hold promise for improving outcomes in TKR patients by addressing obesity, their specific impact on perioperative outcomes and patient health remains largely unquantified by robust clinical trials.