胰高血糖素样肽-1受体激动剂可降低接受初次全膝关节置换术的病态肥胖患者的内科和外科并发症。

Glucagon-Like Peptide-1 Receptor Agonists Decrease Medical and Surgical Complications in Morbidly Obese Patients Undergoing Primary TKA.

作者信息

Kim Billy I, LaValva Scott M, Parks Michael L, Sculco Peter K, Della Valle Alejandro G, Lee Gwo-Chin

机构信息

Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY.

出版信息

J Bone Joint Surg Am. 2025 Feb 19;107(4):348-355. doi: 10.2106/JBJS.24.00468. Epub 2024 Dec 24.

DOI:10.2106/JBJS.24.00468

PMID:39719003

Abstract

BACKGROUND

Weight optimization methods in morbidly obese patients with a body mass index (BMI) of ≥40 kg/m 2 undergoing total knee arthroplasty (TKA) have shown mixed results. The purpose of this study was to evaluate the effect of perioperative use of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) in patients with a BMI of ≥40 kg/m 2 undergoing primary TKA.

METHODS

Using an administrative claims database, patients with morbid obesity undergoing primary TKA were stratified into GLP-1 RA use for 3 months before and after the surgical procedure (treatment group) and GLP-1 RA non-use (control group), and were matched on the basis of patient age, gender, diagnosis of type-2 diabetes mellitus, and Charlson Comorbidity Index (CCI). In addition, these groups were compared with a contemporaneous cohort of patients undergoing TKA with a BMI of 35.0 to 39.9 kg/m 2 . Outcomes including infection, complications, revision, and readmission were compared between the matched cohorts.

RESULTS

There were significant decreases in the rates of 90-day periprosthetic joint infection (PJI) (1.0% compared with 1.8%; p = 0.037), any medical complications (10.6% compared with 12.7%; p = 0.033), pulmonary embolism (<0.4% compared with 0.6%; p = 0.050), and readmissions (5.3% compared with 8.9%; p < 0.001) in patients with a BMI of ≥40 kg/m 2 who were taking GLP-1 RA versus the control group who were not. There were no differences in the 2-year rates of surgical complications (p > 0.05) between these groups. Compared with obese patients (BMI of 35.0 to 39.9 kg/m 2 ), patients who had a BMI of ≥40 kg/m 2 and were taking a GLP-1 RA did not have increased rates of infection or 90-day or 2-year complications (p > 0.05).

CONCLUSIONS

GLP-1 RA administration for at least 90 days prior to and after primary TKA in patients with a BMI of ≥40 kg/m 2 was associated with reductions in the risks of 90-day PJI, any medical complications, and readmission. Additionally, the reduced complication rate that was achieved was similar to that of obese patients with a BMI of 35.0 to 39.9 kg/m 2 undergoing TKA. Randomized clinical trials are needed to define the true effect of these agents on clinical outcomes following TKA.

LEVEL OF EVIDENCE

Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.

摘要

背景

体重指数（BMI）≥40kg/m²的病态肥胖患者在接受全膝关节置换术（TKA）时，体重优化方法的效果不一。本研究的目的是评估围手术期使用胰高血糖素样肽-1受体激动剂（GLP-1 RAs）对BMI≥40kg/m²的患者进行初次TKA的影响。

方法

利用行政索赔数据库，将接受初次TKA的病态肥胖患者分为手术前后使用GLP-1 RA 3个月的组（治疗组）和未使用GLP-1 RA的组（对照组），并根据患者年龄、性别、2型糖尿病诊断和Charlson合并症指数（CCI）进行匹配。此外，将这些组与同期BMI为35.0至39.9kg/m²接受TKA的患者队列进行比较。比较匹配队列之间包括感染、并发症、翻修和再入院在内的结果。

结果

BMI≥40kg/m²且使用GLP-1 RA的患者与未使用的对照组相比，90天假体周围关节感染（PJI）率（1.0%对1.8%；p = 0.037）、任何医疗并发症率（10.6%对12.7%；p = 0.033）、肺栓塞率（<0.4%对0.6%；p = 0.050）和再入院率（5.3%对8.9%；p < 0.001）均显著降低。这些组之间2年手术并发症率无差异（p > 0.05）。与肥胖患者（BMI为35.0至39.9kg/m²）相比，BMI≥40kg/m²且使用GLP-1 RA的患者感染率或90天或2年并发症率没有增加（p > 0.05）。