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Blood glucose levels may signal periprosthetic joint infection after total joint arthroplasty
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There was a correlation between postoperative glucose levels and an increased risk of periprosthetic joint infection after total joint arthroplasty, according to published results.
“The take-home message of our study was that orthopedic surgeons who perform TJA should monitor pre- and postoperative glucose levels in our diabetic and non-diabetic patients and ensure that levels are controlled to reduce the risk of periprosthetic joint infection,” study co-author Antonia F. Chen, MD, told Healio.com/Orthopedics. “Placing patients on postoperative consistent carbohydrate diets may be beneficial during the high-stress perioperative period.”
Researchers performed a retrospective review of 24,857 primary TJAs performed between 2001 and 2015. There were 13,196 TJAs with a minimum 1-year follow-up, with a mean of 5.9 years. Investigators used morning blood glucose levels from postoperative day 1 and associated periprosthetic joint infection, defined by the International Consensus Group on Periprosthetic Joint Infection. The impact of important covariates on infection were determined with multivariable analysis.
Results showed the PJI rate increased linearly from blood glucose levels of 115 mg/dL or greater. There was a significant association between blood glucose levels and PJI. Investigators noted to reduce the chance of PJI, the optimal blood glucose threshold was 137 mg/dL. The entire cohort had a PJI rate of 1.59%. In patients without diabetes vs. those with diabetes, the PJI rate was 1.46% and 2.39%, respectively. Despite a linear trend, blood glucose levels were not significantly associated with PJI in patients with diabetes. – by Monica Jaramillo
Disclosures: Kheir reports he has stock or stock options in Kleu LLC. Please see the full study for a list of all other authors’ relevant financial disclosures.
Perspective
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P. Maxwell Courtney, MD
This thought-provoking study finds a correlation between postoperative hyperglycemia and development of PJI after total hip arthroplasty and total knee arthroplasty. With the recent transition to value-based care, there has been a push by surgeons and policymakers to identify in patients modifiable risk factors for PJI and appropriately optimize these patients prior to surgery. Morbid obesity, uncontrolled diabetes and smoking have been linked to adverse outcomes and increased rates of PJI following THA and TKA. While it has become near universal standard of care to order tests for hemoglobin A1c levels in diabetic patients prior to elective arthroplasty, little attention has been paid to postoperative glycemic control. Based on the authors’ data, patients with a postoperative blood glucose greater than 280 mg/dL had twice the infection rate of patients with normal levels. If we are postponing elective THA and TKA surgery in patients with an elevated hemoglobin A1c level because of an infection risk, maybe we should be more closely monitoring diabetic patients’ glycemic control in the immediate postoperative period.
This study also has practice-changing implications for surgeons who perform outpatient TJA. It may be safer for a diabetic patient to spend a night in the hospital and undergo frequent blood glucose checks to minimize his or her chance for developing PJI.
Rothman Orthopaedic Institute
Thomas Jefferson University
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