Preoperative Use of Glucagon-Like Peptide-1 Receptor Agonists Is Not Protective Against Pseudoarthrosis Following Small Joint Hand Arthrodesis: A Propensity-Matched Analysis

Background: Glucagon-like peptide-1 receptor agonist (GLP-1 RA) use has demonstrated positive effects on bone metabolism and pseudoarthrosis following fusion surgery. There is, however, little evidence regarding the preoperative use of GLP-1 RAs in patients who underwent arthrodesis in the upper extremity. Thus, the objective of this study was to examine the effect of preoperative GLP-1 RA use in patients who underwent small joint arthrodesis of the hand. Methods: This study utilized a global, federated health research network to identify patients that underwent arthrodesis of the interphalangeal (IP) or metacarpophalangeal (MCP) joint. The experimental group consisted of patients that were prescribed a GLP-1 RA within 1 year prior to surgery; the control group had no previous GLP-1 RA exposure. One-to-one propensity matching balanced the groups based on baseline demographic characteristics and medical comorbidities. Rates of pseudoarthrosis and postoperative infection were assessed at 1 year following index procedure. Results: This analysis returned 237 matched pairs. After balancing, the GLP-1 receptor agonist exposed group consisted of 68.4% female and 65.0% White patients. There was no difference between the 2 groups with respect to pseudoarthrosis at 1 year (RR = 0.700, 95% CI [0.362, 1.353]). Furthermore, similar rates of postoperative infection were observed (RR = 1, 95% CI [0.424, 2.358]). Conclusions: Preoperative GLP-1 receptor agonist use was not associated with decreased rates of pseudoarthrosis in patients who underwent IP or MCP arthrodesis. This may suggest that successful union of small joint arthrodesis procedures is more attributable to local biomechanical factors and surgical technique rather than systemic metabolic status.