Preoperative GLP-1 Receptor Agonist Use Is Not Associated With Increased Risk of Pseudoarthrosis Following Midfoot Fusion: A Propensity-Matched Analysis.

BACKGROUND Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are increasingly utilized for the management of Type 2 Diabetes Mellitus (T2DM) and weight loss. While their metabolic benefits are established, their influence on bone metabolism and arthrodesis remains uncertain.

PURPOSE This study aimed to evaluate the association between GLP-1RA use and the incidence of midfoot pseudoarthrosis in diabetic patients.

STUDY DESIGN Retrospective cohort study METHODS: A retrospective analysis was performed using the TriNetX US database. Adults ≥40 years with type 2 diabetes who underwent midfoot arthrodesis were identified. The exposed group included diabetic patients with GLP-1RA exposure within six months preoperatively (n=767), while the control group comprised patients without GLP-1RA use (n=7,306). After 1:1 propensity score matching, 766 patients remained in each cohort. The primary outcome was pseudoarthrosis (ICD-10 code M96.0) within five years. Secondary outcomes included hardware infection, wound complications, and hardware removal within five years.

RESULTS After propensity matching, GLP-1RA users had no statistically significant difference in pseudoarthrosis incidence compared with non-users at 6 months (8.3% vs 6.5%, P>.05), 1 (12.4% vs 9.8%, P>.05), 2 (14.3% vs 11.3%, P>.05), and 5 years (15.0% vs 12.6%, P>.05) postoperatively. At 5 years postoperatively, GLP-1RA exposure was not associated with increased risk of hardware infection, wound complications, or hardware removal.

CONCLUSION Preoperative GLP-1RA exposure was not associated with a higher incidence of pseudoarthrosis following midfoot fusion. These findings support GLP-1RA use in patients undergoing midfoot fusion and contribute to the growing body of literature on GLP-1RA impact on bone metabolism.

LEVEL OF EVIDENCE Level III, retrospective cohort study.