Kim Billy I, LaValva Scott M, Parks Michael L, Sculco Peter K, Della Valle Alejandro G, Lee Gwo-Chin
Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY.
J Bone Joint Surg Am. 2025 Feb 19;107(4):348-355. doi: 10.2106/JBJS.24.00468. Epub 2024 Dec 24.
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.
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.
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).
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.
Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.
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。
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。
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）。
BMI≥40kg/m²的患者在初次TKA前后至少90天使用GLP-1 RA与90天PJI风险、任何医疗并发症和再入院风险降低相关。此外，所实现的并发症率降低与BMI为35.0至39.9kg/m²接受TKA的肥胖患者相似。需要进行随机临床试验来确定这些药物对TKA后临床结果的真正影响。
治疗水平III。有关证据水平的完整描述，请参阅作者指南。
