Patients with Type-1 Diabetes Are at Greater Risk of Periprosthetic Joint Infection

Abstract

Background: The effect of diabetes type on the risk of periprosthetic joint infection is not well documented. We hypothesized that patients with diabetes mellitus type 1 would be at greater risk for periprosthetic joint infection than those with diabetes mellitus type 2 and that a history of diabetic complications would be associated with an increased risk of periprosthetic joint infection. Methods: We performed a retrospective cohort study, within a statewide database, on all adult patients who underwent hip or knee arthroplasty, with follow-up of ≥2 years, from 1996 to 2013. Of the 75,478 patients included, 1,668 had type-1 diabetes and 18,186 had type-2 diabetes. Risk factors were calculated using Cox regression, adjusting for siblings and stratified by age. Logistic regression was used to analyze the effect of diabetic complications on the risk of periprosthetic joint infection, controlling for other known risks for periprosthetic joint infection. Results: There was no difference in age or sex between groups (p > 0.05). The frequency of periprosthetic joint infection in patients without diabetes was 2.6% compared with 4.3% in all patients with diabetes (relative risk, 1.47; p < 0.001). Patients with type-1 diabetes were at a 1.8 times greater risk for periprosthetic joint infection than patients with type-2 diabetes (7% compared with 4%; p < 0.001). The following diabetic complications increased the risk of periprosthetic joint infection: peripheral circulatory disorders (odds ratio [OR], 2.59 [95% confidence interval (CI), 1.70 to 3.94]), ketoacidosis (OR, 2.52 [95% CI, 1.51 to 4.19]), neurological manifestations (OR, 2.33 [95% CI, 1.96 to 2.78]), renal manifestations (OR, 2.15 [95% CI, 1.66 to 2.79]), and ophthalmic manifestations (OR, 1.76 [95% CI, 1.24 to 2.51]). The odds of periprosthetic joint infection increased with each added complication and patients with ≥4 complications were 9 times more likely to have a periprosthetic joint infection than patients with uncomplicated diabetes (OR, 9.47 [95% CI, 4.97 to 18.03]). Overweight and obese patients with type-2 diabetes and underweight patients with type-1 diabetes were at greater risk for periprosthetic joint infection compared with the general population (all p < 0.05). Conclusions: Our data showed an increased risk of periprosthetic joint infection in patients with type-1 diabetes compared with those with type-2 diabetes, along with an increasing risk associated with additional diabetic complications. These findings emphasize the need to better understand the medical history of patients with diabetes for more appropriate risk management. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

The risk factors of the postoperative poor wound healing in spinal tuberculosis patients: A single centre retrospective cohort study

“…Some of the negative finding in our study also interesting, many studies have determined the diabetes is the independent risk factor of wound infection 28‐30 . However, our study suggested that complicated with diabetes is not the risk factor of PWH, which may due to the blood glucose control measurements.…”

“… 26 Plenty of previous studies have approved the preoperative serum albumin is the independent risk factor of wound infection. 28 , 29 , 30 However, we found that it is the postoperative serum albumin rather than preoperative serum albumin is the independent risk factor of the PWH in STB patients. The low postoperative albumin leads to the PWH by hindering fibroblast proliferation and collagen synthesis in the incision tissue, impairing the ability of the immune system and increasing tissue fluid leakage.…”

“…Albumin is thought to predispose patients to SSIs by impairing wound healing and prolonging inflammation via several mechanisms, including impaired fibroblast proliferation and collagen synthesis 26 . Plenty of previous studies have approved the preoperative serum albumin is the independent risk factor of wound infection 28‐30 . However, we found that it is the postoperative serum albumin rather than preoperative serum albumin is the independent risk factor of the PWH in STB patients.…”

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“…Another limit of this study was the inability to grade the severity of comorbidities. Many studies have reported different prognoses for different types and degrees of preexisting diseases[ 22 ]. All of these detailed analyses could not be carried out in our study, which is a limitation.…”