Preoperatively elevated HbA1c levels can meaningfully improve following total joint arthroplasty

Area of Science:

• Orthopedic Surgery
• Endocrinology
• Metabolic Health

Background:

• Diabetic patients with elevated HbA1c undergoing TJA have poorer outcomes.
• No prior studies investigated TJA's effect on glycemic control markers.

Purpose of the Study:

• To evaluate the impact of TJA on postoperative glycemic control.
• To assess the relationship between TJA and glycemic control outcomes in diabetic patients.

Main Methods:

• Retrospective review of 770 diabetic patients undergoing primary elective TJA.
• Analysis of HbA1c levels 3 months pre-surgery and 3-6 months post-surgery.
• Assessment of clinically meaningful HbA1c decrease (>1.0%).

Main Results:

• Patients with preoperative HbA1c >7% were more likely to achieve a meaningful HbA1c decrease post-TJA (24.5% vs 2.9%).
• Higher preoperative HbA1c (>8%) correlated with greater HbA1c reduction.
• Factors like elevated preop HbA1c, smoking, male sex, and African-American race predicted meaningful HbA1c decrease.

Conclusions:

• Elevated preoperative HbA1c in diabetic patients predicts a greater likelihood of meaningful glycemic control improvement after TJA.
• Preoperative medical optimization and enhanced mobility post-TJA likely contribute to improved glycemic control.
• TJA offers a potential pathway for meaningful HbA1c reduction in patients with elevated levels.