Osteoarthritis (OA) is a progressive joint disorder frequently associated with multiple comorbidities. Emerging research suggests a potential link between OA and diabetic retinopathy, a microvascular complication of diabetes mellitus. This study investigates whether joint replacement surgery influences the risk of developing diabetic retinopathy in individuals with OA. Using data from the TriNetX database, we conducted a retrospective cohort study, categorizing OA patients into two groups based on whether they had undergone joint replacement surgery, with each group comprising 164,653 individuals. The primary outcome was the incidence of diabetic retinopathy, analyzed using Cox proportional hazards regression. Among patients who underwent joint replacement surgery, 844 developed diabetic retinopathy, compared to 1,336 cases in the non-surgery group. The incidence of diabetic retinopathy was significantly lower in the surgery group (P < 0.001). Additionally, cumulative incidence analysis confirmed a reduced risk in the surgery group (P < 0.001). Subgroup analyses further demonstrated a consistently lower risk across most demographic subgroups. In conclusion, our findings suggest that joint replacement surgery in OA patients is associated with a reduced risk of developing diabetic retinopathy. Further research is warranted to explore the underlying mechanisms and potential clinical implications.