This webinar is an AAOS member benefit: Members attend for free! 

Description

Preoperative GLP-1 Receptor Agonist Use and Postoperative Outcomes in Orthopaedic Surgery: A Scoping Review of Perioperative and Recovery Outcomes

Introduction:
The rapid expansion of glucagon-like peptide-1 receptor agonist (GLP-1 RA) use for weight management and diabetes has raised perioperative questions, particularly regarding delayed gastric emptying and infection risk. Emerging real-world data suggest a more nuanced perioperative profile. This scoping review synthesizes evidence on preoperative GLP-1 RA exposure and postoperative outcomes across orthopaedic procedures, with emphasis on soft-tissue sports medicine, and is intended to map associative perioperative outcomes rather than establish causality.

Methods:
Following Arksey-O'Malley and Joanna Briggs Institute methodology and PRISMA-ScR reporting, we searched PubMed, Scopus, Web of Science, CINAHL Ultimate, Academic Search Premier, and Ovid Emcare (2015 to 2025). Eligible studies evaluated adult orthopaedic patients with documented GLP-1 RA use and postoperative outcomes. Three reviewers independently screened and extracted study characteristics, exposure timing, perioperative management, and outcomes.

Results:
Of 117 records screened, 35 studies met inclusion. Most were large retrospective cohorts spanning arthroplasty, spine fusion, trauma fixation, foot/ankle fusion, shoulder arthroplasty, and rotator cuff repair. Across hip, knee, and shoulder arthroplasty, GLP-1 RA use was generally associated with similar or lower 90-day complications, reduced periprosthetic joint infection, shorter length of stay, and fewer readmissions or revisions. Spine findings were mixed: Several cohorts showed lower infection and readmission, while others noted increased pneumonia, acute kidney injury, or pseudarthrosis in long-term semaglutide users. Trauma and ankle fracture cohorts showed no increase in short-term complications and in some cases lower mortality, with isolated signals for increased late fall-related injuries. Soft-tissue cohorts (rotator cuff repair and distal radius fixation) demonstrated fewer adverse events without increased aspiration or revision surgery risk. Functional outcomes (PROMIS) were rarely reported.

Conclusion:
Preoperative GLP-1 RA exposure is not broadly associated with increased postoperative risk and often correlates with lower infection, readmission, and mortality rates—particularly in arthroplasty, spine, and ankle fracture fixation cohorts. Findings in spine surgery are more mixed and warrant cautious interpretation, especially with prolonged semaglutide exposure. Outcomes in sports-medicine procedures seem reassuring, although prospective multicenter studies with standardized perioperative protocols and PROMIS-based outcomes are needed.

Learning Objectives

• Review the current evidence regarding preoperative GLP-1 receptor agonist use and its association with postoperative outcomes across common orthopaedic procedures.
• Evaluate the potential benefits and risks of perioperative GLP-1 receptor agonist use, including effects on infection rates, readmissions, complications, and recovery following orthopaedic surgery.
• Compare postoperative outcomes associated with GLP-1 receptor agonist use among arthroplasty, spine, trauma, foot and ankle, and sports medicine procedures, recognizing areas where evidence is consistent and where uncertainty remains.
• Apply current evidence to perioperative decision-making and patient counseling regarding GLP-1 receptor agonist management in orthopaedic surgical practice.

Director

Jonathan Grauer, MD, FAAOS

Co-Authors

Isabella Strickler, BA, Annabella Jensen, BS, Kyle Cragg, BS, Robert Dean, MD, Ryan McNassor, MD, Joe Guettler, MD, FAAOS, James Bicos, MD, FAAOS

The American Academy of Orthopaedic Surgeons is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education (CME) for physicians. The American Academy of Orthopaedic Surgeons designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
 

If you are unable to attend the live webinar, you may still register to be notified upon the availability of the recorded session. Access to the recording will be granted for a duration of 2 years.

This webinar is an AAOS member benefit: Members attend for free!

Description 

Primary elbow osteoarthritis is a functionally disabling condition primarily affecting middle-aged men engaged in manual labor, weightlifting, or throwing. Total elbow arthroplasty is particularly limiting for this population given its lifelong lifting restrictions and long-term complication and revision rates. This webinar reviews the full spectrum of joint-preserving options for such patients. Attention will be given to evaluation of the arthritic elbow, including assessment of blocks to motion, ulnar nerve pathology, and the respective roles of radiographs and CT in staging disease and surgical planning. Discussion will include nonoperative management and its limits, followed by a comparison of arthroscopic and open osteocapsular arthroplasty, including indications, surgical approaches (Outerbridge-Kashiwagi, lateral column, and medial "over-the-top"), reported outcomes, and complication profiles. Particular attention will be paid to ulnar nerve management and delayed-onset ulnar neuritis, a known complication following surgical management. Finally, discussion will conclude around salvage options for advanced disease and guidance on setting realistic patient expectations regarding motion gains and disease progression over time.

Learning Objectives

Upon completion of this webinar, participants will be able to:
1. Perform a thorough history and physical examination of patients with osteoarthritis of the elbow and understand how to use X-ray and advanced imaging for staging and preoperative planning.
2. Describe the evidence supporting operative versus non-operative management of elbow arthritis and recognize appropriate indications for operative intervention.
3. Compare arthroscopic and open osteocapsular arthroplasty with respect to indications, expected outcomes, and potential complications, and identify appropriate indications for concomitant ulnar nerve management.
4. Identify patients who are appropriate candidates for salvage procedures such as interpositional arthroplasty and arthrodesis as an alternative to total elbow arthroplasty.

Webinar Director

Eric Wagner, MD, FAAOS

Co-Authors

Dennis DeBernardis, DO, Tej Joshi, MD, Mandeep Virk, MD, FAAOS

The American Academy of Orthopaedic Surgeons is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education (CME) for physicians. The American Academy of Orthopaedic Surgeons designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
 

If you are unable to attend the live webinar, you may still register to be notified upon the availability of the recorded session. Access to the recording will be granted for a duration of 2 years.