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

May 30, 2026The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons

Use of GLP-1 Medicines Before Surgery Does Not Increase Risk of Bone Healing Problems After Midfoot Fusion

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Abstract

Among 766 matched diabetic patients, preoperative use of GLP-1 receptor agonists showed no significant difference in pseudoarthrosis incidence compared to non-users at 5 years post-surgery.

GLP-1 receptor agonist (GLP-1RA) users had similar rates of pseudoarthrosis compared to non-users at multiple postoperative time points.
At 6 months, the incidence was 8.3% in GLP-1RA users versus 6.5% in non-users.
At 1 year, the rates were 12.4% for GLP-1RA users and 9.8% for non-users.
At 2 years, the incidence was 14.3% for GLP-1RA users and 11.3% for non-users.
At 5 years, 15.0% of GLP-1RA users experienced pseudoarthrosis compared to 12.6% of non-users.
GLP-1RA exposure was not linked to increased risk of hardware infection, wound complications, or hardware removal within five years.

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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.

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

Abstract

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