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Background <p>Bariatric surgery has been associated with increased risks of revision surgery following total knee arthroplasty (TKA), raising concerns about its safety for weight management in this population. Semaglutide, a glucagon-like peptide-1 receptor agonist, has emerged as a promising pharmacologic alternative, though its impact on TKA outcomes remains underexplored. This study compares TKA outcomes between patients who have a history of bariatric surgery and semaglutide use.</p> Methods <p>A retrospective analysis of 19,135 TKA patients from 2012 to 2023 identified three cohorts: patients who used semaglutide (SU, <i>n</i> = 402), had bariatric surgery (BS, <i>n</i> = 418), and a BMI &gt; 35 control group (C, <i>n</i> = 6,650). Demographics, BMI trends, 90-day complications, and revision rates were compared using statistical analyses, including Kaplan-Meier survivorship and multivariate logistic regression.</p> Results <p>Bariatric surgery patients experienced significantly more 90-day emergency department (ED) visits (7.9 [BS] vs. 5.7 [SU] vs. 4.0% [C], <i>P</i> &lt; 0.001) and lower 10-year implant survival (90.3 [BS] vs. 94.5% [C], <i>P</i> = 0.039). Multivariate analysis demonstrated that a history of BS independently predicted increased odds of ED visits (OR 1.79, <i>P</i> = 0.005) and revision (OR 1.71, <i>P</i> = 0.028), while SU was not a significant predictor of adverse outcomes. The BS group achieved the largest preoperative BMI reduction (–1.8&#xa0;kg/m²) vs. SU (–0.7&#xa0;kg/m²) and controls (+ 2.1&#xa0;kg/m²). Notably, the SU cohort regained 1.7&#xa0;kg/m² within three years post-TKA.</p> Conclusion <p>While semaglutide use before TKA was associated with only modest weight loss, it appeared safe and yielded favorable short-term outcomes. Bariatric surgery, though more effective for weight reduction, carried higher complication rates and inferior long-term implant survivorship. Further research is needed to clarify semaglutide’s long-term role in TKA patients with obesity.</p> Level of evidence <p>III.</p>

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Is semaglutide a better weight-management option than bariatric surgery for patients undergoing total knee arthroplasty?

  • 期刊论文

  • 发表日期：

    2026年2月20日

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  • Jonathan Katzman,
  • Zoe Alpert,
  • Mitchell Kennedy,
  • Joshua Rozell,
  • Ran Schwarzkopf,
  • Claudette Lajam

摘要

Background

Bariatric surgery has been associated with increased risks of revision surgery following total knee arthroplasty (TKA), raising concerns about its safety for weight management in this population. Semaglutide, a glucagon-like peptide-1 receptor agonist, has emerged as a promising pharmacologic alternative, though its impact on TKA outcomes remains underexplored. This study compares TKA outcomes between patients who have a history of bariatric surgery and semaglutide use.

Methods

A retrospective analysis of 19,135 TKA patients from 2012 to 2023 identified three cohorts: patients who used semaglutide (SU, n = 402), had bariatric surgery (BS, n = 418), and a BMI > 35 control group (C, n = 6,650). Demographics, BMI trends, 90-day complications, and revision rates were compared using statistical analyses, including Kaplan-Meier survivorship and multivariate logistic regression.

Results

Bariatric surgery patients experienced significantly more 90-day emergency department (ED) visits (7.9 [BS] vs. 5.7 [SU] vs. 4.0% [C], P < 0.001) and lower 10-year implant survival (90.3 [BS] vs. 94.5% [C], P = 0.039). Multivariate analysis demonstrated that a history of BS independently predicted increased odds of ED visits (OR 1.79, P = 0.005) and revision (OR 1.71, P = 0.028), while SU was not a significant predictor of adverse outcomes. The BS group achieved the largest preoperative BMI reduction (–1.8 kg/m²) vs. SU (–0.7 kg/m²) and controls (+ 2.1 kg/m²). Notably, the SU cohort regained 1.7 kg/m² within three years post-TKA.

Conclusion

While semaglutide use before TKA was associated with only modest weight loss, it appeared safe and yielded favorable short-term outcomes. Bariatric surgery, though more effective for weight reduction, carried higher complication rates and inferior long-term implant survivorship. Further research is needed to clarify semaglutide’s long-term role in TKA patients with obesity.

Level of evidence

III.