Common modifiable risk factors in total joint arthroplasty: a 2021 update—diabetes

Preview

Access full article here

Read the full article with your AO login

Access full article here
  • Putting numbers to glycemic control
  • In the name of better outcomes after arthroplasty
  • Is there a better marker for glycemic control than HbA1c?
  • Consistency may be more important
  • Glycemic control should be part of a multimodal optimization
  • Conclusion

Part 2 | Obesity

Preview

Part 3 | Smoking

Preview

Additional AO resources

Access videos, tools, and other assets.

Contributing experts

This series of articles was created with the support of the following specialists (in alphabetical order):

Matthew P Abdel

Mayo Clinic
Rochester, United States

Steven MacDonald

University of Western Ontario
London, Canada

Michael A Mont

Rubin Institute for Advanced Orthopedics
Baltimore, United States

This article was compiled by Maio Chen, Senior Project Manager Medical Writing, AO Foundation, Switzerland.

References

  1. Maradit Kremers H, Schleck CD, Lewallen EA, et al. Diabetes Mellitus and Hyperglycemia and the Risk of Aseptic Loosening in Total Joint Arthroplasty. The Journal of Arthroplasty. 2017 2017/09/01/;32(9, Supplement):S251–S253.
  2. Marchant MH, Jr., Viens NA, Cook C, et al. The impact of glycemic control and diabetes mellitus on perioperative outcomes after total joint arthroplasty. J Bone Joint Surg Am. 2009 Jul;91(7):1621–1629.
  3. Shohat N, Goswami K, Tarabichi M, et al. All Patients Should Be Screened for Diabetes Before Total Joint Arthroplasty. J Arthroplasty. 2018 Jul;33(7):2057–2061.
  4. Adams AL, Paxton EW, Wang JQ, et al. Surgical outcomes of total knee replacement according to diabetes status and glycemic control, 2001 to 2009. J Bone Joint Surg Am. 2013 Mar 20;95(6):481–487.
  5. Ojemolon PE, Shaka H, Edigin E, et al. Impact of Diabetes Mellitus on Outcomes of Patients With Knee Osteoarthritis Who Underwent Knee Arthroplasty: An Analysis of the Nationwide Inpatient Sample. Cureus. 2020 Jun 29;12(6):e8902.
  6. Giori NJ, Ellerbe LS, Bowe T, et al. Many diabetic total joint arthroplasty candidates are unable to achieve a preoperative hemoglobin A1c goal of 7% or less. J Bone Joint Surg Am. 2014 Mar 19;96(6):500–504.
  7. van den Berghe G, Wouters P, Weekers F, et al. Intensive insulin therapy in critically ill patients. N Engl J Med. 2001 Nov 8;345(19):1359–1367.
  8. Bolognesi MP, Marchant MH, Jr., Viens NA, et al. The impact of diabetes on perioperative patient outcomes after total hip and total knee arthroplasty in the United States. J Arthroplasty. 2008 Sep;23(6 Suppl 1):92–98.
  9. George J, Piuzzi NS, Jawad MM, et al. Reliability of International Classification of Diseases, Ninth Edition, Codes to Detect Morbid Obesity in Patients Undergoing Total Hip Arthroplasty. J Arthroplasty. 2018 Sep;33(9):2770–2773.
  10. Association AD. 6. Glycemic Targets: Standards of Medical Care in Diabetes—2021. Diabetes Care. 2021;44(Supplement 1):S73–S84.
  11. Shohat N, Tarabichi M, Tischler EH, et al. Serum Fructosamine: A Simple and Inexpensive Test for Assessing Preoperative Glycemic Control. J Bone Joint Surg Am. 2017 Nov 15;99(22):1900–1907.
  12. Jämsen E, Nevalainen P, Kalliovalkama J, et al. Preoperative hyperglycemia predicts infected total knee replacement. Eur J Intern Med. 2010 Jun;21(3):196–201.
  13. Iorio R, Williams KM, Marcantonio AJ, et al. Diabetes mellitus, hemoglobin A1C, and the incidence of total joint arthroplasty infection. J Arthroplasty. 2012 May;27(5):726–729.e721.
  14. Harris AH, Bowe TR, Gupta S, et al. Hemoglobin A1C as a marker for surgical risk in diabetic patients undergoing total joint arthroplasty. J Arthroplasty. 2013 Sep;28(8 Suppl):25–29.
  15. Han HS, Kang SB. Relations between long-term glycemic control and postoperative wound and infectious complications after total knee arthroplasty in type 2 diabetics. Clin Orthop Surg. 2013 Jun;5(2):118–123.
  16. Stryker LS, Abdel MP, Morrey ME, et al. Elevated postoperative blood glucose and preoperative hemoglobin A1C are associated with increased wound complications following total joint arthroplasty. J Bone Joint Surg Am. 2013 May 1;95(9):808–814, s801–802.
  17. Hwang JS, Kim SJ, Bamne AB, et al. Do glycemic markers predict occurrence of complications after total knee arthroplasty in patients with diabetes? Clin Orthop Relat Res. 2015 May;473(5):1726–1731.
  18. Chrastil J, Anderson MB, Stevens V, et al. Is Hemoglobin A1c or Perioperative Hyperglycemia Predictive of Periprosthetic Joint Infection or Death Following Primary Total Joint Arthroplasty? J Arthroplasty. 2015 Jul;30(7):1197–1202.
  19. Cancienne JM, Werner BC, Browne JA. Is There a Threshold Value of Hemoglobin A1c That Predicts Risk of Infection Following Primary Total Hip Arthroplasty? J Arthroplasty. 2017 Sep;32(9s):S236–S240.
  20. Citak M, Toussaint B, Abdelaziz H, et al. Elevated HbA1c is not a risk factor for wound complications following total joint arthroplasty: a prospective study. Hip Int. 2020 Sep;30(1_suppl):19–25.
  21. Shohat N, Restrepo C, Allierezaie A, et al. Increased Postoperative Glucose Variability Is Associated with Adverse Outcomes Following Total Joint Arthroplasty. J Bone Joint Surg Am. 2018 Jul 5;100(13):1110–1117.
  22. Shohat N, Tarabichi M, Tan TL, et al. 2019 John Insall Award: Fructosamine is a better glycaemic marker compared with glycated haemoglobin (HbA1C) in predicting adverse outcomes following total knee arthroplasty: a prospective multicentre study. Bone Joint J. 2019 Jul;101-b(7_Supple_C):3–9.
  23. Jämsen E, Nevalainen PI, Eskelinen A, et al. Risk factors for perioperative hyperglycemia in primary hip and knee replacements. Acta Orthop. 2015 Apr;86(2):175–182.