Perioperative Glucagon-Like Peptide-1 Receptor Agonist Therapy and Postoperative Outcomes in Adult Foot and Ankle Surgery: A Scoping Review.

Abstract

Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are emerging as a cornerstone in the management of type 2 diabetes and obesity. The perioperative implications of GLP-1RAs in orthopaedic surgery are a growing area of interest; however, their effects in patients undergoing foot and ankle surgery remain uncertain. This scoping review aims to map the available evidence on the use of GLP-1RAs in adults undergoing foot and/or ankle surgical procedures. We aim to examine the impact of perioperative GLP-1RA use on postoperative outcomes in adults undergoing foot and/or ankle surgery. We systematically searched PubMed, Embase, the Cochrane Library, Web of Science, and Scopus from January 2000 to July 2025. We included English-language full-text studies reporting on adult patients receiving GLP-1RAs who underwent foot and/or ankle surgery. Primary outcomes were bone union and early hardware removal after ankle fracture fixation. Secondary outcomes included infection, wound complications, reoperation, and post-traumatic arthritis. This scoping review was conducted in accordance with the PRISMA-ScR guidelines and the Joanna Briggs Institute (JBI) framework for scoping reviews. A total of 102 records were identified, of which 88 remained after duplicate removal and underwent title and abstract screening. Three articles proceeded to full-text review; one was excluded because it investigated semaglutide in patients with chronic ankle instability without surgical intervention. Two retrospective, propensity-matched cohort studies using the TriNetX federated database met the inclusion criteria. Adults with diabetes undergoing tibiotalar, subtalar, or triple arthrodesis were evaluated and a lower overall rate of postoperative pseudarthrosis was reported among GLP-1RA users compared with matched controls (15.9% vs 20.2%; p = 0.0129). Subgroup analyses showed lower pseudarthrosis rates after subtalar fusion and triple arthrodesis in GLP-1RA users, with no significant difference after isolated tibiotalar fusion. Adults undergoing open reduction and internal fixation (ORIF) of ankle fractures were examined, and patients not receiving GLP-1RAs had a significantly higher 30-day hardware removal rate compared with GLP-1RA users (odds ratio 1.953; 95% confidence interval 1.062-3.591; p = 0.028). Neither study demonstrated an increased risk of postoperative infection or long-term complications in GLP-1RA users. Current literature suggests that perioperative GLP-1RA use is associated with lower rates of pseudarthrosis after hindfoot arthrodesis and a reduced need for early hardware removal after ankle fracture fixation, without an apparent increase in postoperative infection or long-term complications. However, the evidence is limited, heterogeneous, and based solely on two retrospective database analyses with incomplete perioperative detail and potential residual confounding. This scoping review highlights a substantial gap in the literature regarding the use of GLP-1RAs in foot and ankle surgery and underscores the need for robust prospective studies to clarify the perioperative safety and efficacy of GLP-1RAs in adults undergoing foot and ankle surgery.