Perioperative Glycemic Variability Influences Infection Rates Differently Following Revision Hip and Knee...

Area of Science:

• Orthopedic surgery
• Endocrinology
• Infectious disease

Background:

• Abnormal postoperative glycemia is linked to adverse events after total joint arthroplasty.
• This study investigated the association between hyperglycemia, glycemic variability, and periprosthetic joint infection (PJI) after aseptic revision total joint arthroplasty.

Purpose of the Study:

• To determine if postoperative hyperglycemia and glycemic variability are associated with PJI within two years after aseptic revision total joint arthroplasty.
• To identify risk factors for PJI in revision hip and knee arthroplasty patients.

Main Methods:

• Retrospective review of 2,208 patients undergoing aseptic revision total joint arthroplasty (2012-2019).
• Analysis of postoperative glucose values and glycemic variability using coefficient of variation, mean amplitude of glycemic excursions, and J-index.
• Logistic regression analyses to assess associations with PJI at 90-day, 1-year, and 2-year follow-up.

Main Results:

• In revision hips, only mean amplitude of glycemic excursions predicted PJI at one year (P=0.045); body mass index was consistently associated with PJI.
• In revision knees, glycemic measures were not associated with PJI, but PJI rates differed significantly between diabetics and non-diabetics at all time points (P<0.05).

Conclusions:

• Reducing preoperative body mass index and postoperative glycemic variability may decrease PJI rates in revision hip surgery.
• Patients with diabetes have a persistently higher risk of PJI after revision knee surgery, irrespective of perioperative glucose management.