For those with type 2 diabetes who have knee osteoarthritis, getting a knee replacement can be difficult because they are more likely to have surgical complications.
A team of Yale orthopedic surgeons found that taking semaglutide, a glucagon-like peptide-1 (GLP-1) receptor agonist, before a knee replacement can improve outcomes for these patients. Their findings were published in the Journal of Arthroplasty.
Total knee replacement is a common operation that relieves pain and restores function in people with severe knee osteoarthritis. However, those with diabetes often face more challenges during recovery. Diabetes and obesity can lead to increased inflammation, and diabetic patients are more likely to experience challenges after surgery.
Semaglutide is a medication that manages diabetes by improving blood sugar levels, helping with weight loss, and reducing inflammation. This study, led by principal investigator Lee Rubin, MD, professor of orthopaedics & rehabilitation at Yale School of Medicine, examined how the medication affected patients with diabetes who underwent knee replacements.
The researchers looked at how long patients needed to be on semaglutide to see improvements during recovery, grouping patients based on how long they took semaglutide before surgery. The groups ranged from less than one month to more than six months. The team then compared the surgical outcomes to patients not taking the medication.
The study found that even taking semaglutide for less than a month before surgery had benefits, such as fewer minor complications like wound issues, bleeding, kidney problems, pneumonia, and infections. Importantly, taking the medication for at least two to three months before surgery reduced more severe complications like infections, sepsis, blood clots, heart problems, and pancreatitis.
"Our team found that three months of semaglutide use prior to surgery leads to markedly fewer minor and severe complications,” Rubin says. “The results open a new avenue for preoperative health optimization for patients with diabetes seeking joint replacement and underscores the importance of multidisciplinary collaboration among specialists. By working with primary care physicians, endocrinologists, and nurse navigators, we can better prepare our diabetic patients for surgery, leading to improved recovery and overall health outcomes."
Rubin’s team also published another recent study on how semaglutide improved clinical outcomes for patients with diabetes undergoing shoulder joint replacement, known as total shoulder arthroplasty.
Researchers saw similar results. Shoulder replacement patients on semaglutide also had much lower odds of surgical site infection, cardiac events, venous thromboembolism, pneumonia, urinary tract infection, acute kidney injury, and emergency department visits.
The research team is now exploring the impact of semaglutide on hip replacements, along with other types of joint reconstruction. They aim to verify if semaglutide consistently improves surgical outcomes, and if so, these findings would then change how preoperative care is managed for patients with diabetes prior to major surgeries.
This study is a step forward in improving preoperative care for diabetics undergoing knee replacement surgery, showing that three months of semaglutide can make a substantial difference in recovery and overall health outcomes.
According to Rubin, studies on the optimal dosage and the anti-inflammatory properties of semaglutide are needed to solidify their findings and develop better preoperative care protocols. Additionally, making semaglutide more accessible can help many patients benefit from its positive effects.
In addition to Rubin, the co-authors include Anthony Seddio, MD; Rajiv Vasudevan, MD; Michael Gouzoulis, MD; Jeremy Ansah-Twum, MD; and Jonathan Grauer, MD.