Postoperative hyperglycaemia control reduces postoperative complications in patients subject to total knee arthroplasty

Reátegui, Diego; Tornero, Eduard; Popescu, Dragos; Sastre, Sergi; Camafort, Miguel; Gines, Gracia; Combalía, Andrés; Lozano, Luís

doi:10.1016/j.knee.2016.09.011

Cited by 8 publications

(8 citation statements)

References 31 publications

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“…Patients who did not participate in PCP care had an independent predictor of medical complications of surgical infections and mechanical complications. The study confirmed that decrease HbA1c level is related to less medical complications [33].…”

Section: Introductionsupporting

confidence: 68%

Hip Fractures Risk and Postoperative Period in Elderly Diabetic Patients

Skowronek¹,

Piątkiewicz²,

Lewandowicz³

et al. 2017

J Diabetes Metab

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Hip fractures with the numbers about 1.6 million over the world in 2000 are serious health problem which drastically limits the functionality and increases mortality in geriatric population. Peritrochanteric and neck hip fractures result from the reduction of mineral bone density or impaired quality, however age related co-morbidities add additional risk related to increased incidence of falls. The one of the diseases found to increase hip fractures incidence and associated mortality is diabetes which currently affects 415 million adults over the world with increasing prevalence, predicted to 642 million by 2040. Type 1 diabetes contributes to fragility by unfavorable changes in bone metabolism. Although type 2 diabetes effects on bone may be paradoxically opposed, it still increases risk of falls and hip fractures. The causes of increased fractures risk via precedent falls comprise of diabetic angio and neuropathic complications affecting central nervous system, vision, balance and also results from polypharmacy. Diabetes influences also the postoperative period, deteriorating wounds healing and promoting sores formation. The scope of diabetes impact on hip fractures risk and orthopaedic surgery results should be particularly considered together with proper glycemic control to prevent postoperative complications and improve patient prognosis.

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Section: Introductionsupporting

confidence: 68%

Hip Fractures Risk and Postoperative Period in Elderly Diabetic Patients

Skowronek¹,

Piątkiewicz²,

Lewandowicz³

et al. 2017

J Diabetes Metab

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“…These results are congruent, at least partially, with ours and are likely related to revision for postoperative infection. Other studies have also illustrated that comorbidities, including obesity, could affect the presence of postoperative infection [25,26], which usually occurs within the first year after arthroplasty and can culminate in the need for early revision. Therefore, future research using postoperative complications as an outcome and considering comorbidity as an explanatory factor could help clarify the influence of comorbidity on the risk of revision [25,27,28].…”

Section: Discussionmentioning

confidence: 99%

Impact of comorbidity on the short- and medium-term risk of revision in total hip and knee arthroplasty

Torre

Smith

Dregan

et al. 2020

BMC Musculoskelet Disord

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Background: The impact of comorbidity on the risk of revision in patients undergoing Total Knee arthroplasty (TKA) and Total Hip Arthroplasty (THA) is not currently well known. The aim of this study was to analyze the impact of comorbidity on the risk of revision in TKA and THA. Methods: Patients recorded in the Catalan Arthroplasty Register (RACat) between 01/01/2005 and 31/12/2016 undergoing TKA (n = 49,701) and THA (n = 17,923) caused by osteoarthritis were included. As main explanatory factors, comorbidity burden was assessed by the Elixhauser index, categorized, and specific comorbidities from the index were taken into account. Descriptive analyses for comorbidity burden and specific conditions were done. Additionally, incidence at 1 and 5 years' follow-up was calculated, and adjusted Competing Risks models were fitted. Results: A higher incidence of revision was observed when the number of comorbidities was high, both at 1 and 5 years for THA, but only at 1 year for TKA. Of the specific conditions, only obesity was related to the incidence of revision at 1 year in both joints, and at 5 years in TKA. The risk of revision was related to deficiency anemia and liver diseases in TKA, while in THA, it was related to peripheral vascular disorders, metastatic cancer and psychoses. Conclusions: Different conditions, depending on the joint, might be related to higher revision rates. This information could be relevant for clinical decision-making, patient-specific information and improving the results of both TKA and THA.

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“…All TKA procedures were performed using the same surgical protocol. [ 15 ] A low-pressure (250 mmHg) ischemia cuff tourniquet was used on the patient's thigh. The articular approach was medial para-patellar with patellar eversion.…”

Section: Methodsmentioning

confidence: 99%

Local infiltration analgesia for total knee arthroplasty: Does a mixture of ropivacaine and epinephrine have an impact on hemodynamics? An observational cohort study

et al. 2020

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Purpose: High doses of local anesthetic administered intra-articularly and peri-articularly during local infiltration analgesia (LIA) for total knee arthroplasty (TKA) may have potential effects on patient hemodynamics. The aim of this study was to know if hemodynamic changes are associated with LIA in patients undergoing TKA. Methods: In a prospective observational design, elective patients undergoing orthopedic surgery for TKA and treated with LIA consisting of a mixture of ropivacaine (300 mg) and epinephrine (1 mg) were investigated for changes in selected hemodynamic parameters: heart rate (HR), non-invasively registered mean arterial blood pressure (MAP), and incidence of arrhythmias during the perioperative course, consisting of the following periods: period 1. from establishment of spinal anesthesia to prior to LIA administration, period 2. from administration of LIA to before release of ischemia tourniquet, period 3. from release ischemia tourniquet to end of surgery, and period 4. from transfer to the post anesthesia care unit to the ward. Statistical analysis was done with ANOVA-RM for the difference in means in repeated measurements, and with the Tukey Test between pairs. Data are presented as mean ± standard deviation. A P value <0.05 was considered significant. Results: Ninety-nine patients (mean age 77 ± 8 years) were included. HR increased from period 2 to period 3 up to 16% (67 ± 14 to 77 ± 13 bpm, P < 0.001), and from period 2 to period 4 up to 21% (67 ± 14 to 81 ± 12 bpm, P < 0.001). MAP showed no significant changes from period 2 to period 3 (89 ± 13 to 87 ± 13 mmHg, P > 0.50), and from period 2 to period 4 (89 ± 13 to 91 ± 11 mmHg, P > 0.50). No arrhythmias were detected during follow-up. Conclusions: A mixture of ropivacaine and epinephrine for LIA, despite the high doses administered, does not have a negative impact on hemodynamics.

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Postoperative hyperglycaemia control reduces postoperative complications in patients subject to total knee arthroplasty

Cited by 8 publications

References 31 publications

Hip Fractures Risk and Postoperative Period in Elderly Diabetic Patients

Hip Fractures Risk and Postoperative Period in Elderly Diabetic Patients

Impact of comorbidity on the short- and medium-term risk of revision in total hip and knee arthroplasty

Local infiltration analgesia for total knee arthroplasty: Does a mixture of ropivacaine and epinephrine have an impact on hemodynamics? An observational cohort study

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