Conference Coverage

Tirzepatide Has Lower Joint Infection Risk Than Other GLP-1s After Arthroplasty

Edited by:
Brian McCurdy

Key Highlights

  • Two-year periprosthetic joint infection rates in 6,964 patients were 1.01% with tirzepatide and 1.58% with other GLP-1 receptor agonists.
  • Tirzepatide was also associated with lower revision arthroplasty risk at 1 and 2 years.
  • Short-term complications were similar between groups, and sensitivity analyses supported the primary findings.

Tirzepatide use was associated with lower risks of periprosthetic joint infection (PJI) and revision surgery than use of other glucagon-like peptide-1 receptor agonists (GLP-1 RAs) among patients undergoing primary total joint arthroplasty. The retrospective cohort analysis, presented at the 2026 American Association of Hip and Knee Surgeons Annual Meeting, examined adults aged ≥50 years undergoing total hip or knee replacement.

Tirzepatide is a dual glucose-dependent insulinotropic polypeptide/GLP-1 receptor agonist. The study focused on whether outcomes differed from those observed with other GLP-1 RAs in patients undergoing joint replacement.

Researchers used the TriNetX network to identify patients who underwent primary total hip or knee arthroplasty between 2022 and 2026. An active-comparator, new-user design compared tirzepatide users with users of other GLP-1 RAs. Perioperative exposure was defined using a window extending one year before through 1 year after surgery.

The primary outcome was PJI within 2 years. Secondary outcomes included PJI at 1 year, all-cause revision arthroplasty, and complications within 30 days. Investigators used multivariable Cox and logistic regression models. Additional analyses included propensity score matching, a direct comparison with semaglutide, and landmark analysis.

Study Findings

After matching the propensity score, the analysis included 6,964 patients in each group. PJI occurred in 1.01% of tirzepatide users versus 1.58% of patients using other GLP-1 RAs at 2 years. Tirzepatide was associated with a lower hazard of PJI (hazard ratio [HR], 0.73; 95% CI, 0.54–0.99). The investigators reported that findings were consistent across sensitivity analyses.

Revision arthroplasty risk also favored tirzepatide. The HR was 0.59 (95% CI, 0.41–0.86) at 1 year and 0.61 (95% CI, 0.45–0.81) at 2 years. Short-term complications were similar between treatment groups.

Clinical Implications

According to the authors, the associations with lower PJI and revision risks suggest a potentially incremental benefit of tirzepatide compared with other GLP-1 RAs in patients undergoing total joint arthroplasty.

Expert Commentary

“These findings suggest a potentially incremental benefit of tirzepatide in patients undergoing total joint arthroplasty,” the researchers concluded.

Reference

Wang CT, Lee CC, Tseng TH. Tirzepatide is associated with lower joint infection risk vs. GLP-1s after total joint arthroplasty. Paper #51. Abstract presented at the American Association of Hip and Knee Surgeons Annual Meeting, November 5–8, 2026, Dallas, TX.