Orthopedic Outcomes and GLPs: More Than Glucose and Weight Loss

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GLP-1 receptor agonists (GLP-1 RAs), commonly prescribed for type 2 diabetes (T2DM) and obesity, may affect orthopedic outcomes beyond glucose control. This study evaluated whether preoperative use of GLP-1 RAs affects postoperative outcomes in T2DM patients undergoing ankle fracture surgery.

 

Study design and patient matching

 

Researchers conducted a retrospective cohort analysis of adults with T2DM who underwent ankle fracture repair. Patients were grouped based on GLP-1 RA use within 180 days pre-surgery. After 1:1 propensity matching for demographics, comorbidities, and lab values, outcomes were assessed across three domains: 

 

• 90-day medical complications

• 90-180-day operative/implant-related issuesHealth care use at 30, 90, and 190 days post-op

 

Key findings

 

Matched cohorts included 1,107 patients each. Compared to non-users, GLP-1 users showed:

 

• Lower all-cause mortality: OR 0.33; P = .011; NNT = 56

• Higher incidence of fall-related injuries: OR 1.32; P = .011; NNH = 15

• No differences in infection, wound healing, opioid use, or posttraumatic arthritis

 

Clinical implications

 

Preoperative GLP-1 RA use in T2DM patients undergoing ankle fracture repair may lower mortality but increase fall risk. These findings highlight that orthopedic surgical care in the context of GLP-1 therapy and the need for ongoing study. 

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The Pendulum Is Swinging: Total Ankle vs. Ankle Arthrodesis 

by Vince Vacketta, DPM

 

Ankle arthrodesis (AA) has long been regarded as the gold standard procedure for end-stage ankle arthritis (ESAA). But in 2025, with significant advancements in total ankle arthrodesis (TAA,) it’s worth asking: does that consensus still hold?

 

Head-to-head review

 

A recent systematic review titled Clinical Outcomes and Safety Profile for Total Ankle Arthroplasty and Ankle Arthrodesis for Symptomatic Ankle Arthritis set out to answer that question. The study analyzed comparative data from multiple sources, focusing on clinical outcomes, complication rates, and the frequency of revision or reoperation between AA and TAA.

 

What the data shows

 

The findings were striking. TAA was associated with significantly fewer complications across several key metrics:

 

• Total complications were markedly lower: 13.1% for TAA vs. 31.4% for AA

• Implant removal occurred less frequently: 8.5% vs. 20%

• Adjacent level fusion was reduced: 5.1% vs. 13.4%

• Nonunion or open reduction and internal fixation was rare: 1.6% vs. 7.2%

 

Interestingly, no notable differences were found on patient-reported outcomes.

 

Shifting perspectives

 

Taken together, these results suggest that TAA offers a safer post-operative profile, with fewer complications and lower revision rates when compared to AA. In my view, it also brings the added benefit of earlier weightbearing and faster recovery, translating to reduced debilitation, lower fall risk, and earlier return to activities of daily life. While AA will always have a place in ESAA surgery, the expanding role of TAA reflects a broader evolution as the field advances.

 

 

Ligaments Are More Horizontal in Progressive Collapsing Foot Deformity (PCFD)

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PCFD involves progressive ligamentous and bone changes. While osseous deformities are well described, ligament orientation is the focus of this investigation.

 

Study design

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This retrospective study reviewed MRI and radiographs 39 patients – 23 PCFD and 16 controls. MRI was used to measure the coronal orientations of three ligaments: the cervical, the interosseous talocalcaneal, and superomedial spring ligaments. Radiographs assessed talonavicular coverage, Meary angle, talar declination, Kite angle, and calcaneal pitch.

 

Key insights

 

Patients with PCFD showed significantly more horizontal ligament orientations compared to controls:

 

• Cervical ligament: 25.5° in PCFD vs. 45° in controls (P < .001)

• Superomedial spring ligament: 11.5° vs. 23.1° (P <. 001)

• Interosseous talocalcaneal: 39.5° vs. 49° (P = .005)

 

Radiographs showed classic deformity patterns, including:

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• Reduced talonavicular coverage: 64.5% in PCFD vs. 80.9% in controls

• Increased Meary angle: 22.2° vs. −2.3°

• Elevated talar declination: 37° vs. 20.6°

• Decreased calcaneal pitch: 15.5° vs. 24.6°

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What it means

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Nonweightbearing MRI reveals that patients with PCFD have more horizontally oriented subtalar ligaments, suggesting altered ligament alignment contributes to deformity. ​​​