New research shows that GLP-1 medications like Ozempic, Wegovy, Mounjaro, and Zepbound may lower the short-term risk of needing hip or knee replacement in patients with arthritis and obesity. They may also reduce knee pain in a meaningful way. GLP-1s do not reverse advanced arthritis. For many patients, they are a useful tool to delay surgery, improve surgical candidacy, or make joint replacement safer when it is eventually needed.
The question I hear every week, “Can GLP-1s Help You Avoid Joint Replacement?”
A patient sits down across from me in Franklin, Tennessee. They set down their phone. Then they ask some version of this question. “Dr. Calendine, I just started Ozempic. My knees already feel better. Do I still need this replacement?”
It is a fair question. It deserves a careful answer. GLP-1 medications have moved from diabetes clinics into almost every area of medicine, including my operating room. The research from the last year is changing how I talk with patients about timing, candidacy, and what weight loss can and cannot do for an arthritic joint.
For the surgeon-facing version of this conversation, I wrote a piece for Becker’s Spine Review. It walks through the seven statistics every joint replacement surgeon should know. This article is the patient version, with the practical context I give my own patients when asked, “Can GLP-1s help you avoid joint replacement?”.
What GLP-1 medications actually are
GLP-1 stands for glucagon-like peptide-1. It is a hormone your gut releases after you eat. It tells your brain you are full. It slows how fast your stomach empties. It also helps your pancreas release insulin. GLP-1 receptor agonists are medications that mimic this hormone.
You probably know them by brand name:
- Semaglutide (Ozempic, Wegovy)
- Tirzepatide (Mounjaro, Zepbound)
- Liraglutide (Victoza, Saxenda)
These drugs were first developed for type 2 diabetes. They are now widely prescribed for obesity. The numbers have exploded. One recent review found a 700% jump in GLP-1 use among non-diabetic patients over the last four years. Many of those patients are my patients. Many more will be soon.
How can GLP-1s help you avoid joint replacement?
The short answer is sometimes, and only for some patients. The research is real. But the picture is more nuanced than the headlines suggest.
What a large study of 237,000 patients found
A 2025 study in the Orthopaedic Journal of Sports Medicine looked at more than 237,000 patients with known hip or knee arthritis. Patients who were prescribed a GLP-1 had:
- A 40% lower risk of hip replacement within one year
- A 25% lower risk of knee replacement within one year
Those numbers are significant. But read the fine print. The study measured risk of surgery within one year. It did not prove the arthritis got better. It did not prove cartilage grew back. What it shows is that weight loss and better metabolic health delayed the need for surgery in a meaningful number of patients.
What the STEP 9 trial showed about pain
The STEP 9 trial was published in the New England Journal of Medicine in 2024. It is the cleanest data we have on GLP-1s and knee pain. Patients with obesity and moderate knee arthritis took weekly semaglutide. Their WOMAC pain scores dropped by 41.7 points on average. Patients not on a GLP-1 had scores drop by 27.5 points.
That 14-point gap matters. Patients felt better, and not just on paper. WOMAC scores measure real things. Getting out of a chair. Climbing stairs. Sleeping through the night.
Some of the benefit comes from weight loss. Every pound of body weight adds roughly four pounds of force across the knee with every step. Lose 15 pounds and your knee feels 60 pounds lighter. Some of the benefit may come from the drug’s direct anti-inflammatory effect. Researchers are still working out how that piece fits in.
Where GLP-1s cannot help you
I want to be straight with my patients about the limits of these drugs. A GLP-1 will not:
- Regrow cartilage that has worn away
- Reverse a bone-on-bone knee or hip
- Fix a mechanical alignment problem
- Repair a torn labrum or meniscus
If your X-rays show end-stage arthritis and your joint is failing, weight loss alone will not restore function. It may slow the progression. It may reduce your pain. It will not rebuild the joint.
GLP-1s are a tool that can buy time and improve outcomes. They are not a substitute for surgery when surgery is truly needed.
Who is the best candidate for a GLP-1 trial?
I think about this differently based on where a patient is on the arthritis spectrum.
Strong candidates for a GLP-1 trial first
You may benefit most from trying a GLP-1 before surgery if:
- You have mild to moderate arthritis on imaging
- Your BMI is elevated and weight loss would reduce joint load
- You have type 2 diabetes or prediabetes along with your joint pain
- You have heart risk factors that surgery would be safer without
- You are not yet in severe daily pain
Patients who likely need surgery regardless
You probably should not delay surgery for a GLP-1 trial if:
- Your imaging shows end-stage, bone-on-bone arthritis
- You have lost function despite conservative treatment
- Pain wakes you at night and limits basic activities
- You have locking, catching, or giving way
- You have already tried physical therapy, injections, and activity changes
Weight loss still matters for these patients. The main reason to pursue it is to make eventual surgery safer, not to avoid it.
Making surgery safer when it is still needed
This part of the story does not make the headlines, but it should. Even when GLP-1s do not help patients avoid surgery, they often make the surgery itself safer.
A large meta-analysis of 346,899 patients who had hip or knee replacement found that GLP-1 users had a lower rate of joint infection at 90 days. They also had a lower rate of reoperation at 90 days.
A Hospital for Special Surgery study in JBJS looked at morbidly obese patients. GLP-1 users had a joint infection rate of 1.0%. Patients not on a GLP-1 had a rate of 1.8%. Readmission rates dropped from 8.9% to 5.3%.
Joint infection is one of the most feared complications in joint replacement. Cutting that rate nearly in half is a big deal. For patients with obesity, a well-timed GLP-1 course before surgery may be one of the most effective risk-reduction tools we have.
What patients get wrong about GLP-1 knee replacement, hip replacement and joint pain
A few common misunderstandings come up almost every week.
“If my pain went away, my arthritis must be gone.” Not true. Pain relief is not the same as joint repair. Many patients feel much better on a GLP-1. They assume the arthritis has resolved. The cartilage has not grown back. If you stop the drug and regain the weight, the pain often comes back with it.
“I can just stay on Ozempic forever and skip surgery.” For some patients, this may work. For others, the arthritis keeps progressing under the symptom relief. Regular follow-up with imaging matters. Do not mistake a quiet joint for a healthy joint.
“I do not need to exercise because the drug is doing the work.” This one worries me. GLP-1s can cause muscle loss along with fat loss, especially without strength training. Your quadriceps, hips, and core are the scaffolding that supports your joints. Losing that scaffolding while your cartilage wears down is the worst of both worlds. If you are on a GLP-1, you need to be more attentive to strength training, not less.
The conversation to have with your surgeon
If you are on a GLP-1 and considering joint replacement, bring these points up at your next visit:
- What drug you are taking, at what dose, and for how long
- Whether you are using it for diabetes, obesity, or both
- How much weight you have lost and how fast
- Whether your pain has changed since starting
- What your current activity level and strength look like
- How can GLP-1s you avoid joint replacement
- Any muscle loss or weakness you have noticed
A good orthopedic surgeon will not just ask about your GLP-1 as a checkbox. They should understand how it fits into your joint health, your metabolic health, and your long-term goals.
The bottom line – “Can GLP-1s help you avoid joint replacement?”
GLP-1 medications are one of the most interesting developments in joint health I have seen in my career. For some of my patients, they delay the need for surgery. For others, they make surgery safer. For a few, they change the path of knee or hip arthritis.
They are not a cure for arthritis. They are not a substitute for surgery when surgery is truly needed. They are a real option worth discussing. They deserve a place in the conversation between you and your surgeon.
If you are considering hip or knee replacement in Middle Tennessee, or trying to decide whether you can delay it, the best next step is a thoughtful consultation. That means looking at your imaging, your function, your history, and your goals together. That is the kind of conversation we have every day at my practice.
