Elevated fructosamine levels linked with increased PJI risk
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Fructosamine can be a good glycemia screening tool and elevated levels can have a predictive role for periprosthetic joint infection in patients who undergo elective total hip arthroplasty, according to presented results.
“Fructosamine is inexpensive and readily available marker. It is better reflects the glucose levels prior to surgery. So, it is a better reflector and predictor of outcomes and responds quicker to treatment,” Noam Shohat, MD, said at the American Association of Hip and Knee Surgeons Annual Meeting.
In a prospective multi-institutional study, Shohat and colleagues evaluated preoperative fructosamine and HbA1c levels in patients who had elective THA from November 2017 to August 2018. The total patient cohort was 1,212 patients, and patients with and without diabetes were enrolled. Researchers assessed fructosamine and HbA1c levels 2 to 3 weeks preoperatively. Adverse outcomes, such as PJI, wound complications, readmission and mortality, were assessed at 1 year postoperatively. A fructosamine level greater than 293 mol/L defined inadequate glycemic control and as a predictor for adverse outcomes.
Primary outcome was PJI as defined by the 2018 criteria of the International Consensus Meeting on Musculoskeletal Infection. Shohat and colleagues used univariate and multivariate regression to evaluate the association between preoperative fructosamine levels and the development of adverse outcomes and PJI.
Overall, 960 patients were available for follow-up at 1 year, at which time 3.5% of patients showed inadequate glycemic control based on fructosamine value. Shohat said an unexpected finding was that among patients with elevated fructosamine, 85% were unaware they had pre-diabetes and 42% were unaware they had diabetes.
He said PJI and mortality rates were six times higher in patients with high fructosamine. Readmission rates were five times higher in patients with high fructosamine. Patients with high fructosamine groups had PJI rates of almost 10% and readmission rates of 16%.
The association between high fructosamine levels and increased risk for PJI was statistically significant after investigators adjusted for age, comorbidities and preoperative HbA1c levels in a regression analysis.
In addition, based on these findings, the recommendation is to screen all patients prior to surgery using fructosamine, Shohat said.
“Those with levels above 293 [mol/L], we strongly encourage you to reconsider the need for surgery,” he said.
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Shohat N, et al. Paper 9. Presented at: American Association of Hip and Knee Surgeons Annual Meeting; Nov. 5-8, 2020; Dallas (hybrid meeting).
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