Some people don’t qualify for joint replacement surgeries because of their weight, while others experience complications as a result of it. But weight loss medications are helping to change that.

July 12, 2026 - By Meg Dalton - For most of her life, Susan wasn’t overweight. But after she turned 50, that changed. She started gaining about 10 pounds every year. Within 10 years, she was 100 pounds overweight. 

“That is what destroyed my knees,” she said. “My right knee became bone on bone. One day, it just started hurting like hell.” 

So, Susan did something about it. (Her name has been changed for privacy reasons.) In November 2020, she got a total knee arthroplasty (TKA) at a hospital in central Connecticut. For a few months, she felt better. But the pain soon returned. Eventually, she learned that one of the prosthetic components in her knee replacement had loosened from the bone about four months after the surgery. 

Studies show that people with higher body mass index (BMI) are more likely to experience serious complications both during and after joint replacement surgery. (Body mass index is a measure of body fat based on height and weight.) Because of this, many hospitals and surgeons now have BMI “cutoffs,” limiting who is eligible for certain joint replacement surgeries. 

For some patients, these cutoffs can mean being denied the orthopedic they need altogether. For others, like Susan, it can mean having surgeries in which there is an increased risk of failed prosthetics, infection, or other complications.

But a new kind of drug might close this gap: GLP-1s. Weight loss drugs like Ozempic and Zepbound can help patients who might otherwise not qualify for joint replacement surgeries have greater access to care – and undergo safer and more effective surgeries. 

Susan, who is now 65, has lost 93 pounds since starting on the GLP-1. And working with her new care team at Yale — which includes experts in orthopedics and weight management — she is now preparing for a revision surgery of her right knee as well as a TKA of her left knee.

“I feel like I’m in good hands,” she said. “I’m doing my part, and they’re going to do their part. Together, we are going to get my knees back to when I was 45.”

Comprehensive care 

In May 2023, after experiencing lingering knee pain more than two years following her knee replacement surgery, Susan met with Lee Rubin, the hip and knee joint reconstruction chief and the Kristaps J. Keggi Professor of Orthopedics and Rehabilitation at Yale School of Medicine (YSM)

During that visit, Rubin helped to drive home the relationship between extra weight and knee pain, and why patients who are overweight often have complications during knee replacement.

“I sit down and talk with patients about the issues at hand,” Rubin said. “I talk about the surgical risks and the infection risk — which are real and are measurable — and how we don’t want those for any patient. We want to get them relief.”

At Yale, Susan soon found a multidisciplinary care team that has helped her to reach a healthy target weight that is right for her — and to reduce the risks of surgical complications.

The Yale collaboration offers a unique referral pathway from orthopedics to the Yale Center for Weight Management, Rubin says. Within the electronic health records system used at Yale (known as Epic), these teams use an order pathway that connects patients directly with the staff at the center to receive expert assessment and guidance for their obesity as a key part of the overall management. 

Oftentimes, these patients have been denied care outright by other medical institutions because of their weight, whereas at Yale, the comprehensive care team works hard to set those patients up for success by creating an individualized pathway for them.

“Yale is a place that allows physicians to come up with solutions to challenging problems in new ways and to organize how we care for patients in ways based on the things we’re learning and researching,” Rubin said. 

The center — which is part of Yale School of Medicine and Yale New Haven Health — is a multidisciplinary practice offering a comprehensive range of services for patients needing help to achieve their target weight. It includes a clinic specialized for patients who require both joint surgery and weight management; there, the team conducts a comprehensive evaluation of patients, looking at everything from nutrition and exercise to sleep patterns and other stress factors in their lives. 

And increasingly, GLP-1s have emerged as a way for these care teams to help patients qualify for life-changing surgeries which they might have otherwise been ineligible for. Specialists from across multiple disciplines help the patients reach a “green zone” whereby they’re cleared for surgery. 

‘Clear risk reduction’

Not all hospitals have BMI thresholds or cutoffs for joint replacement surgery. But in those that do, patients above the BMI threshold have increased risks of infection, heart attack, stroke, return to the operating room, and mortality, says Daniel Wiznia, associate professor of orthopaedics & rehabilitation at YSM.

In addition, Wiznia’s research has shown that enforcement of strict BMI cutoffs may unintentionally limit access to joint replacement for certain groups, such as for Hispanic and Black patients. For example, if someone has a hip or knee replacement, achieving mobility after surgery may take longer if a patient has a higher BMI, he said. The sooner people can get up and moving after joint replacement, the less likely they are to get infections or blood clots.

“There is a need for targeted health optimization for patients as the central focus of preparation for joint replacement surgery, rather than dismissing patients based strictly on their BMI,” Wiznia said.

“If a patient’s weight can be brought down before surgery, then they may not have many of these complications,” said Wajahat Mehal, professor of medicine (digestive diseases) and medical director of the Yale Center for Weight Management. 

The center will often prescribe GLP-1s if a patient’s BMI is over 30 in order to improve the chances that surgery will be successful. (According to the Centers for Disease Control and Prevention, a healthy BMI for adults is between 18.5 and 24.9.) These GLP-1s are typically prescribed in conjunction with dietary counseling, lifestyle changes, and more. For these patients, the first step is a healthy lifestyle. “These medications are not a substitute for a healthy lifestyle,” Mehal said.

Added Rubin: “The medication, along with some dietary changes and exercise, goes a long way.”

So far, the medications have been effective at helping patients lose weight so that they can become safer surgical candidates. In addition to helping with weight loss, there are other benefits to taking GLP-1s prior to their joint surgery. At least one paper, published in the Journal of Arthroplasty and authored by a team of YSM faculty and residents, found that semaglutide appears to offer significant protective benefits against surgical complications for diabetic patients who are undergoing a total knee replacement. 

“The patients had a clear risk reduction when they have the joint replacement surgery, if they’ve been on the GLP-1,” Rubin said. “It is critical to bring these research findings into our clinical practices at Yale to improve patient outcomes.”

Using GLP-1s for less than a month was enough to start reducing minor adverse events such as wound issues or infections, the researchers found, but a minimum of 2 to 3 months of continuous use before surgery is required to significantly reduce the odds of severe adverse events such as major infections, blood clots, or cardiac events. 

This data suggests that patients should aim for at least a 3-month period of preoperative semaglutide exposure to maximize their protection against both minor and severe complications following knee replacement surgery, Rubin said.

“Ultimately, when they’ve had the new joint replacement and they’ve lost the weight, the quality of life goes through the roof,” Rubin said. 

Regaining muscle memory

Two years ago, Susan started on Zepbound, an injectable medication that activates two receptors in the body called GIP and GLP-1. 

“I’ve got to say that the Zepbound has changed my life,” she said. 

Eventually, she started feeling pain in her left knee, and Rubin confirmed she would need a replacement for that knee, too. 

Because of the complications of her first knee surgery, Susan wants to lose all the recommended weight before she has either surgery. So far, she’s lost 93 pounds but wants to lose another 17 before the surgery. Already, her knee pain has diminished substantially. 

Prior to gaining weight, Susan had always led an active life. She used to walk 20 miles every week. She loved to ski. She even competed in triathlons. 

“I think that I’ve got some muscle memory,” she said. “The more weight I lose, the more I’m able to do things that require strength like in my legs and in my arms.”

As soon as she recovers from her revision surgery, she’s looking forward to one thing: A pain-free walk along the 2-mile sandy stretch of beach in Madison, Hammonasset Beach State Park.

Source: Yale School of Medicine