The Prevalence of Diabetes Mellitus and Routine Hemoglobin A1c Screening in Elective Total Joint Arthroplasty Patients

Capozzi, James D.; Lepkowsky, Eric; Callari, Marie M.; Jordan, Ellen T.; Koenig, Jan; Sirounian, Gregory H.

doi:10.1016/j.arth.2016.06.025

Cited by 54 publications

(43 citation statements)

References 37 publications

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“…Patients with diabetes have impaired wound healing, reduced osteoblast capacity, and poorer immune defence mechanisms . Up to 22% of patients undergoing TKA in the US have concomitant diabetes, and up to one‐third have undiagnosed dysglycaemia . A systematic review of observational studies found that patients with diabetes have an increased incidence of several catastrophic complications, including deep infection (odds ratio [OR], 1.61; 95% CI, 1.38–1.88), deep vein thrombosis (OR, 2.57; 95% CI, 1.58–4.20), and aseptic loosening (OR, 9.36; 95% CI, 4.63–18.90) .…”

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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“…Between 8% and 22% of patients who undergo TJA have diabetes, 25 and about one third have undiagnosed hyperglycemia. 26 Diabetes, especially when uncontrolled, is a significant risk factor for SSI. 27 Even nondiabetic patients who develop hyperglycaemia postoperatively have a significantly increased risk of SSI, 28 with SHEA recommending that post-operative glucose levels be maintained < 180 mg/dL.…”

Section: Peri-operative Measuresmentioning

confidence: 99%

Prevention of periprosthetic joint infection

Parvızı

Shohat

Gehrke

2017

The Bone & Joint Journal

143

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The World Health Organization (WHO) and the Centre for Disease Control and Prevention (CDC) recently published guidelines for the prevention of surgical site infection. The WHO guidelines, if implemented worldwide, could have an immense impact on our practices and those of the CDC have implications for healthcare policy in the United States. Our aim was to review the strategies for prevention of periprosthetic joint infection in light of these and other recent guidelines. Cite this article: Bone Joint J 2017;99-B(4 Supple B):3–10.

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“…Some patients may have had multiple laboratory drawings within the perioperative window and thus may underestimate the cost of THA for such patients. Additionally, it has been reported that up to 33% of patients may have HbA1c values within the prediabetic range [12]. Because patients in this study had to have both an HbA1c value and a diagnosis of DM, the influence of HbA1c on cost may only apply to the diabetic population.…”

Section: Discussionmentioning

confidence: 99%

“…Complications following THA have been identified as one of the leading cost drivers [19]. It has been well studied that patients with DM undergoing THA are at an increased risk of complications such as superficial site infections, periprosthetic joint infections, aseptic loosening, increased length of stay, and increased total hospital costs [8,11,12,20]. A positive correlation between rising HbA1c levels and increased risk of infection and cost has been shown [21].…”

Section: Discussionmentioning

confidence: 99%

“…Previous research has demonstrated that patients who undergo THA are at an increased risk of superficial site infections, periprosthetic joint infections, aseptic loosening, increased length of stay, and increased total hospital costs [8–11]. This has increased awareness regarding patient optimization before surgery and some sites have established cutoff limits for glycosylated hemoglobin A1c (HbA1C) [12]. However, cutoff thresholds for HbA1c are often unachievable by patients and many with an HbA1c over an optimal threshold will still undergo the THA [13].…”

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confidence: 99%

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