Determining the Threshold for HbA1c as a Predictor for Adverse Outcomes After Total Joint Arthroplasty: A Multicenter, Retrospective Study

Tarabichi, Majd; Shohat, Noam; Kheir, Michael M.; Adelani, Muyibat A.; Brigati, David P.; Kearns, Seán; Patel, Pankajkumar; Clohisy, John C.; Higuera, Carlos A.; Levine, Brett R.; Schwarzkopf, Ran; Parvızı, Javad; Jiranek, William A.

doi:10.1016/j.arth.2017.04.065

Cited by 108 publications

(68 citation statements)

References 34 publications

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“…It appears that higher cut‐offs are required for routine HbA 1C screening to have predictive value. A retrospective study found a large increase in prosthetic infection in patients with HbA 1C levels > 60.7 mmol/mol, while another found an association at levels > 63.9 mmol/mol . Given these retrospective studies are subject to bias, there is no high level evidence to support the routine screening of glycaemic control in TKA candidates.…”

Section: Optimising Pre‐operative Status To Maximise Recovery and Attmentioning

confidence: 99%

Selecting and optimising patients for total knee arthroplasty

Adie

Harris

Chuan

et al. 2019

Medical Journal of Australia

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Summary The minimum requirements for total knee arthroplasty (TKA) are significant, prolonged symptoms with supporting clinical and radiological signs. Despite interest in screening tools, there is limited evidence for a specific symptom threshold that justifies surgery. Non‐operative treatments including medications, exercise and weight loss are unlikely to reverse radiographic changes, but they may improve symptoms and delay the need for surgery. Many patient factors such as mental health and obesity affect both the level of symptomatic improvement after surgery and risks of surgery, but none have been identified as contraindications for the procedure as significant health gains can still be achieved. Although age and sex are associated with patient‐reported outcomes and risk of revision, these factors cannot be used to restrict access to TKA, and age cut‐offs are not recommended. Evidence regarding pre‐operative optimisation of patients to improve post‐operative TKA outcomes is limited by the few interventional trials available, particularly in the areas of patient expectation, diabetes, obesity and vascular disease. There is good evidence from randomised controlled trials that pre‐operative rehabilitation primarily focusing on exercises for the joint or limb has minimal effect on post‐operative TKA outcomes, and there is some evidence from randomised controlled trials that an intensive smoking cessation program before surgery may improve post‐operative outcomes. Detailed international guidelines exist on the optimisation of the cardiorespiratory status of surgical patients, and these should be followed for TKA surgery.

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Section: Optimising Pre‐operative Status To Maximise Recovery and Attmentioning

confidence: 99%

Selecting and optimising patients for total knee arthroplasty

Adie

Harris

Chuan

et al. 2019

Medical Journal of Australia

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“…The number of DM patients who need to undergo THA or TKA have been increasing [9]. As many literatures have stated the associations between the postoperative infections and DM or a high level of HbA1c in the fi eld of cardiothoracic surgery [4][5][6][7], it was also reported that the patients that underwent total joint arthroplasty with DM had a signifi cantly higher risk of postoperative PJI than that of the patients without DM [10][11][12][13][14][15]. For example, Hwang et al reported that the patients with the preoperative blood glucose levels >200 mg/dL and HbA1c levels >8.0 mg/dl were at the risk for wound complications after total knee arthroplasty [13].…”

Section: Discussionmentioning

confidence: 99%

“…For example, Hwang et al reported that the patients with the preoperative blood glucose levels >200 mg/dL and HbA1c levels >8.0 mg/dl were at the risk for wound complications after total knee arthroplasty [13]. Tarabichi et al reported that the HbA1c level over 7.7 mg/dL was associated with a higher risk of postoperative PJI [15]. Although it has been reported that it is important to control the postoperative glucose levels to decrease the rate of PJI [10], there are few reports about the association with hyperglycemia and PJI.…”

Section: Discussionmentioning

confidence: 99%

Perioperative hyperglycemia and postoperative periprosthetic joint infection (PJI) after total knee and hip arthroplasty

Maeda¹,

Nakamura²,

Sugano³

2018

Ann Musculoskelet Med

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Background: The quantitative relationship based on infection after total joint arthroplasty and perioperative blood glucose levels are not fully discussed. Hypothesis: The purpose of this study was to fi nd the relationship between peri-operative hyperglycemia and infection after total joint arthroplasty by suggesting a cutoff value over which were the risk factor for postoperative infection. Materials and Methods: A total of 234 patients (209 women, 25 men) who underwent total knee or hip arthroplasty from October 2012 to March 2014 met the inclusion criteria. There were 78 total knee arthroplasty (TKA) and 158 total hip arthroplasty (THA) cases. Of all, 33 had a history of diabetes mellitus (DM). We had followed up for a minimum of 1year postoperatively. The blood glucose levels for two days postoperatively before each meal and the fasting blood glucose (FBG) levels at 1, 2 and 3 weeks after surgery in the morning were measured and compared between the infected and non-infected groups. Results: Higher preoperative HbA1c levels over 7.0 mg/dL, the blood glucose levels at two days over 200 mg/dL, and the FBG levels at one week over 140 mg/dL was higher infection rate after TJA than any other factors. Discussions: FBG levels should be monitored cautiously and we treated tight to maintain the blood glucose level under such cutoffs .

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“…A similar rationing of care is taking place regarding risk factors such as perioperative glucose control and tobacco use (Table 1). Preoperatively predicting perioperative glucose control remains challenging, however, and the validity of using hemoglobin A1c, which measures a collective 90‐days of serum glucose control, as a surrogate measure has recently been questioned 32–34 . Alternative tests such as perioperative serum glucose levels and fructosamine have been described as more sensitive measures of perioperative glucose control, and have demonstrated promise in preoperative screening for high‐risk patients 35,36 .…”

Section: New Advancements In Prevention Of Pjimentioning

confidence: 99%

New developments and future challenges in prevention, diagnosis, and treatment of prosthetic joint infection

Ricciardi

Muthukrishnan

Masters

et al. 2020

Journal Orthopaedic Research

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Prosthetic joint infection (PJI) is a devastating complication that results in substantial costs to society and patient morbidity. Advancements in our knowledge of this condition have focused on prevention, diagnosis, and treatment, in order to reduce rates of PJI and improve patient outcomes. Preventive measures such as optimization of patient comorbidities, and perioperative antibiotic usage are intensive areas of current clinical research to reduce the rate of PJI. Improved diagnostic tests such as synovial fluid (SF) α‐defensin enzyme‐linked immunosorbent assay, and nucleic acid‐based tests for serum, SF, and tissue cultures, have improved diagnostic accuracy and organism identification. Increasing the diversity of available antibiotic therapy, immunotherapy, and alternative implant coatings remain promising treatments to improve infection eradication in the setting of PJI.

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Determining the Threshold for HbA1c as a Predictor for Adverse Outcomes After Total Joint Arthroplasty: A Multicenter, Retrospective Study

Cited by 108 publications

References 34 publications

Selecting and optimising patients for total knee arthroplasty

Selecting and optimising patients for total knee arthroplasty

Perioperative hyperglycemia and postoperative periprosthetic joint infection (PJI) after total knee and hip arthroplasty

New developments and future challenges in prevention, diagnosis, and treatment of prosthetic joint infection

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