Outcomes of Glucagon-Like-Peptide-1 Receptor Agonists (Glp-1A) and Patients Undergoing Total Shoulder Arthroplasty (TSA): A Systematic Review and Meta-Analysis

Introduction Glucagon-like peptide-1 receptor agonists (GLP-1a) medications have rapidly gained popularity. However, the full impact these medications may have on the outcomes of Total Shoulder Arthroplasty (TSA) remain to be determined. The objective of this systematic review and meta-analysis is to evaluate the outcomes of patients undergoing any TSA (both anatomic or reverse) while on a GLP-1a medication versus those not on any GLP-1a medication undergoing TSA. Methods A search was conducted across MEDLINE/PubMed, Cochrane, Google Scholar, Web of Science, and Embase databases. The search used a combination of keywords and Medical Subject Headings (MeSH) terms, such as “glucagon-like-peptide-1-receptor agonists” or “total shoulder arthroplasty”, with the full search insupplementary table 1. Titles and abstracts were screened for eligibility according to the inclusion criteria. Full texts were screened, and those that met the eligibility criteria were included. Inclusion criteria included any studies that 1.) Evaluated patients undergoing any TSA (including reverse and anatomic TSA) and reported to be taking GLP-1a medication at the time of undergoing TSA, 2.) They were completed in English. Revision arthroplasty was excluded. Demographics and results of the studies were extracted from the articles that met the inclusion criteria. Meta-analysis was conducted to evaluate outcomes. Results In this systematic review, six studies met the inclusion criteria, and five studies were included for meta-analysis. No studies were deemed poor quality by the quality assessment. When compared with patients not using GLP-1a medications, patients using GLP-1a medications in the setting of TSA demonstrated no significant difference in readmissions (OR: 1.12 (95% CI: 0.86-1.44); P=0.40), infections (OR: 0.98 (95% CI: 0.53-1.80); P=0.94), or medical complications (OR: 0.89 (95% CI: 0.45-1.79); P=0.75) within 90 days of surgery. At 2 years, these patients had no significant difference in aseptic revision (OR: 1.66 (95% CI: 0.97-2.84); P=0.07), periprosthetic fractures (OR: 1.16 (95% CI: 0.65-2.05); P=0.62), or infections (OR: 1.42 (95% CI: 0.92-2.19); P=0.12). Conclusion This study supports the safe use of GLP-1a medications in patients undergoing TSA. This study found no difference in 90-day readmissions, 90-day medical complications, 90-day and 2-year infections, 2-year periprosthetic fractures, and 2-year aseptic revisions when comparing patients using GLP-1a medications when undergoing TSA to those not using GLP-1a medications. Level of Evidence III Systematic Review & MetaAnalysis