BACKGROUND: The purpose of this study was to evaluate the effects of preoperative oral carbohydrate (CHO) loading on postoperative insulin resistance, hospital stay, and pain in patients undergoing elective arthroplasty. METHODS: Clinical randomized controlled trials on the effects of preoperative oral CHO loading in patients undergoing elective hip and knee arthroplasty were searched on PubMed, Web of Science, Cochrane Library, Embase, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure (CNKI) from inception to February 2024. The Cochrane Risk of Bias Assessment Tool was used to evaluate the quality of the enrolled randomized controlled trials. RESULTS: There were 16 papers included. Meta-analysis unveiled that compared with the control group, the test group had notably reduced postoperative anxiety scores [standardized mean difference = -0.06, 95% CI (confidence interval) (-0.42 to 0.30)] and complication rates [OR (odds ratio) = 0.64, 95% CI (0.41 to 0.99)] and enhanced postoperative active GLP-1 levels after preoperative oral CHO loading [standardized mean difference = 0.46, 95% CI (0.06 to 0.86)]. There was no marked difference in postoperative blood glucose levels, hospitalization time, insulin levels, and pain score. CONCLUSIONS: Available evidence suggests that preoperative oral CHO loading in patients undergoing arthroplasty may reduce related complications, improve postoperative active GLP-1 levels, and alleviate postoperative anxiety.