Diego Reátegui1, Eduard Tornero2, Dragos Popescu3, Sergi Sastre3, Miquel Camafort4, Gracia Gines5, Andrés Combalía2, Luis Lozano3. 1. Trauma and Orthopaedics Department, Hospital Clinic, Barcelona, Spain. Electronic address: diego_reategui@hotmail.com. 2. Trauma and Orthopaedics Department, Hospital Clinic, Barcelona, Spain. 3. Knee Unit, Trauma and Orthopaedics Department, Hospital Clinic, Barcelona, Spain. 4. Internal Medicine Department, Dermatology and Medicine Institute, Hospital Clinic, Barcelona, Spain. 5. Nursery Knee Unit, Trauma and Orthopaedics Department, Hospital Clinic, Barcelona, Spain.
Abstract
BACKGROUND: The aim of our study was the early detection and treatment of patients with unknown alterations of the hydrocarbon metabolism subject to total knee arthroplasty in order to reduce the incidence of postoperative complications. METHODS: Patients were classified as non-diabetic patients (group 1), diabetic patients (group 2) and patients with stress hyperglycaemia (group 3). The last two groups were recommended assessment by a primary care physician (PCP). After one year follow-up the groups were compared with respect to incidence of postoperative complications. The groups were also compared regarding the decrease or increase of HbA1c levels with the incidence of complications. RESULTS: Of the 228 patients, 116 (50%) were included in group 1, 40 (17.5%) in group 2 and 72 (31.6%) in group 3. Patients that consulted their PCP presented lower medical complication rates than those who did not (9.2% vs. 26.4%, P=0.020). Not being attended by a PCP was an independent predictive factor of medical complication (odds ratio (OR): 21.3; 95% confidence interval (95% CI): 4.6-98.5), surgical site infection (OR: 4.1; 95% CI: 1.1-15.0) and mechanical complication (OR: 5.0; 95% CI: 1.3-18.8). A decrease of HbA1c value was related to less medical systemic complications (7.3% vs. 24.2%, P=0.035). CONCLUSIONS: Patients with hyperglycaemia during the postoperative total knee arthroplasty period, who are controlled by the PCP present lower incidence of complications. Decrease of HbA1c value during postoperative total knee arthroplasty period leads to a lower rate of medical complications.
BACKGROUND: The aim of our study was the early detection and treatment of patients with unknown alterations of the hydrocarbon metabolism subject to total knee arthroplasty in order to reduce the incidence of postoperative complications. METHODS:Patients were classified as non-diabeticpatients (group 1), diabeticpatients (group 2) and patients with stress hyperglycaemia (group 3). The last two groups were recommended assessment by a primary care physician (PCP). After one year follow-up the groups were compared with respect to incidence of postoperative complications. The groups were also compared regarding the decrease or increase of HbA1c levels with the incidence of complications. RESULTS: Of the 228 patients, 116 (50%) were included in group 1, 40 (17.5%) in group 2 and 72 (31.6%) in group 3. Patients that consulted their PCP presented lower medical complication rates than those who did not (9.2% vs. 26.4%, P=0.020). Not being attended by a PCP was an independent predictive factor of medical complication (odds ratio (OR): 21.3; 95% confidence interval (95% CI): 4.6-98.5), surgical site infection (OR: 4.1; 95% CI: 1.1-15.0) and mechanical complication (OR: 5.0; 95% CI: 1.3-18.8). A decrease of HbA1c value was related to less medical systemic complications (7.3% vs. 24.2%, P=0.035). CONCLUSIONS:Patients with hyperglycaemia during the postoperative total knee arthroplasty period, who are controlled by the PCP present lower incidence of complications. Decrease of HbA1c value during postoperative total knee arthroplasty period leads to a lower rate of medical complications.
Authors: Jorge Arias-de la Torre; Kayla Smith; Alexandru Dregan; Jose M Valderas; Jonathan P Evans; Daniel Prieto-Alhambra; Luis Lozano; Antonio J Molina; Vicente Martín; Laia Domingo; Laura Muñoz; Mireia Espallargues Journal: BMC Musculoskelet Disord Date: 2020-07-09 Impact factor: 2.362