Surgical Outcomes of Total Knee Replacement According to Diabetes Status and Glycemic Control, 2001 to 2009

Adams, Annette L.; Paxton, Elizabeth W.; Wang, Jean Q.; Johnson, Eric S.; Bayliss, Elizabeth A.; Ferrara, Assiamira; Nakasato, Cynthia; Bini, Stefano A.; Namba, Robert S.

doi:10.2106/jbjs.l.00109

Cited by 143 publications

(116 citation statements)

References 20 publications

Supporting

Mentioning

113

Contrasting

Order By: Relevance

“…Our study is in concordance with several previous studies. Our finding of no association of HbA 1c level of 7 as the cutoff value with infection or wound complication is in concordance with previous studies reporting no increased complications after TKA in patients with uncontrolled blood glucose levels when using an HbA 1c level of 7 as the cutoff [1,7]. A previous study found an association between HbA 1c levels C 8 and wound complications but no association with early postoperative deep infection in patients with DM after TKA [6].…”

Section: Discussionsupporting

confidence: 91%

“…Hence, achieving optimal glycemic control in patients with DM is important. However, evidence for which glycemic markers are most predictive of complications is less clear [1,6,7,9,16,21]. We wanted to determine the correlations among the four commonly used glycemic markers and to identify the glycemic markers that were most strongly associated with the occurrence of surgical site infections and postoperative wound complications in patients with DM after undergoing TKA.…”

Section: Discussionmentioning

confidence: 99%

“…A retrospective review of 4241 TKAs or THAs performed at a single center found that patient HbA 1c levels were not reliable predictors of the risk of infection after total joint arthroplasty [7]. Furthermore, the conventional cutoff HbA 1c level of less than or equal to 7 was reported to have poor predictive value for the development of postoperative wound complications and prosthetic joint infection (PJI) [1]. Other measures for assessment of patient glycemic control are preoperative fasting blood glucose (FBG) and postoperative random blood glucose levels.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Do Glycemic Markers Predict Occurrence of Complications After Total Knee Arthroplasty in Patients With Diabetes?

Hwang

Kim

Bamne

et al. 2015

Clinical Orthopaedics &Amp; Related Research

104

View full text Add to dashboard Cite

Background Patients with diabetes have increased risk of infections and wound complications after total knee arthroplasty (TKA). Glycemic markers identifying patients at risk for complications after TKA have not yet been elucidated. Questions/purposes We aimed to determine the correlations among four commonly used glycemic markers and to identify the glycemic markers most strongly associated with the occurrence of surgical site infections and postoperative wound complications in patients with diabetes mellitus after undergoing TKA. Methods Our retrospective study included 462 patients with diabetes, who underwent a total of 714 TKAs. Blood levels of glycemic markers, including preoperative fasting blood glucose (FBG), postprandial glucose (PPG2), glycated hemoglobin (HbA 1c ), and levels obtained from random glucose testing on postoperative days 2, 5, and 14, were collected on all patients as part of a medical clearance program and an established clinical pathway for patients with diabetes at our center. Complete followup was available on 93% (462 of 495) of the patients. Correlations among markers were assessed. Associations between the markers and patient development of complications were analyzed using multivariate regression analyses of relevant cutoff values. We considered any of the following as complications potentially related to diabetes, and these were considered study endpoints: surgical site infection (superficial and deep) and wound complications (drainage, hemarthrosis, skin necrosis, and dehiscence). During the period of study, there were no fixed criteria applied to what levels of glycemic control patients with diabetes needed to achieve before undergoing arthroplasty, and there were wide ranges in the levels of all glycemic markers; for example, whereas the mean HbA 1c level was 7%, the range was 5% to 11.3%.Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research 1 editors and board members are on file with the publication and can be viewed on request. Each author certifies that his or her institution has approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent was obtained. This work was performed at the Joint Reconstruction Center, Seoul National University Bundang Hospital, Seoul, Republic of Korea. Results There were positive correlations among the levels of the four glycemic markers; the strongest correlation was found between the preoperative HbA 1c and PPG2 levels (R = 0.502, p \ 0.001). After controlling for potential confounding variables using multivariate analysis, the HbA 1c cutoff level of 8 (odds ratio [OR], 6.1; 95% confidence interval...

show abstract

Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Do Glycemic Markers Predict Occurrence of Complications After Total Knee Arthroplasty in Patients With Diabetes?

Hwang

Kim

Bamne

et al. 2015

Clinical Orthopaedics &Amp; Related Research

104

View full text Add to dashboard Cite

show abstract

“…Marchant et al found that patients who had uncontrolled DM, defined as a hemoglobin A1c greater than 7.0, had higher odds of stroke, urinary tract infection, ileus, postoperative hemorrhage, transfusion, wound infection, and death when compared to patients with controlled DM [12]. However, perioperative hyperglycemia has actually been shown to be a more accurate predictor of postoperative complications [13]. As such, it is important to maintain tight control of glucose levels in the perioperative setting.…”

Section: Diabetesmentioning

confidence: 99%

Improving Quality and Decreasing Cost by Reducing Re-admissions in Patients Undergoing Total Joint Arthroplasty

Sveom¹,

Otteman²,

Garvin³

2017

Curr Rev Musculoskelet Med

View full text Add to dashboard Cite

Purpose of review Total joint arthroplasty (TJA) has had an increased demand over the recent years. It is a successful procedure, and there are relatively few complications, but there is a high overall cost. There is a push to increase the quality of care, lessen complications, and decrease cost by reducing readmissions. This article will discuss the risk factors that can contribute to the complication and readmission rates following TJA. Recent findings Several risk factors have been found to contribute to the complication and readmission rates following a TJA. It is important to understand these risk factors and mitigate them as much as possible in order to optimize the patient experience. There are risk factors that cannot be modified, and the treatment team as well as the patient should be made aware of these and account for them when making the decision whether to undergo elective primary TJA or not. In general, an increased number of risk factors is associated with increased complications and increased readmission rates. At our institution, we have used this knowledge to improve our outcomes and decrease costs. Summary It is important to be mindful of risk factors for poor outcomes prior to performing TJA. This allows for the optimization of patients prior to undergoing surgery. This can lead to improved outcomes at a lower cost.

show abstract

“…Similarly, compared to patients without DM, there was no association between uncontrolled DM and risk of revision (OR 1.03; 95% CI 0.68 -1.54) (5).…”

Section: Resultsmentioning

confidence: 88%

Antibiotic Prophylaxis in Periprosthetic Joint Infection (PJI): literature Review and World Consensus (Part Seven)

Parvızı

Ghazavi

2016

Shafa Ortho J

View full text Add to dashboard Cite

Context: There is a need to find if patients with poorly controlled diabetes, immunosuppression, or autoimmune disease require different perioperative antibiotic prophylaxis. There is also a need to determine if antibiotic prophylaxis should be different for primary cases, revision cases, hip arthroplasty and knee arthroplasty. The best antibiotic prophylaxis to choose in patients with colonization by carbapenem resistant enterobacteriaceae or multi-drug resistant (MDR)-Acinetobacter spp needs to be determined. Evidence Acquisition: Delegates in workgroup 3 of the consensus meeting on PJI reviewed English literature for relevant articles. 30 of 221 articles were relevant to the 4 following questions regarding perioperative antibiotic prophylaxis to prevent PJI. Results: There is no need to use different antibiotic prophylaxis for patients with poorly controlled diabetes, immunosuppression, or autoimmune disease than routine antibiotic prophylaxis. Perioperative antibiotic prophylaxis should be the same for primary and uninfected revision arthroplasty. Perioperative antibiotic prophylaxis should be the same for hips and knees arthroplasties. There is insufficient data to recommend expanded antibiotic prophylaxis in patients known to be colonized or recently infected with multi-drug resistant pathogens. Conclusions: Based on evidences in the literature and consensus of expert delegates from consensus meeting recommendations for type of antibiotic prophylaxis in patients with poorly controlled diabetes, immunosuppression, or autoimmune disease, primary and uninfected revision arthroplasty, hip or knee arthroplasties and patients known to be colonized or recently infected with multidrug resistant pathogens were provided.

show abstract

Surgical Outcomes of Total Knee Replacement According to Diabetes Status and Glycemic Control, 2001 to 2009

Cited by 143 publications

References 20 publications

Do Glycemic Markers Predict Occurrence of Complications After Total Knee Arthroplasty in Patients With Diabetes?

Do Glycemic Markers Predict Occurrence of Complications After Total Knee Arthroplasty in Patients With Diabetes?

Improving Quality and Decreasing Cost by Reducing Re-admissions in Patients Undergoing Total Joint Arthroplasty

Antibiotic Prophylaxis in Periprosthetic Joint Infection (PJI): literature Review and World Consensus (Part Seven)

Contact Info

Product

Resources

About