BACKGROUND: Diabetes is highly prevalent in patients with osteoarthritis before total joint arthroplasty and presents a higher risk of adverse postoperative outcomes. However, the rate of diabetes in this population and optimal screening strategies remain unknown. METHODS: We prospectively screened patients undergoing elective total joint arthroplasty for diabetes using glycated hemoglobin (HbA1c) and fasting blood glucose (FBG) levels. Screening was conducted within 2 time periods between 2012 and 2017. The prevalence of diabetes was assessed using a previous diagnosis of diabetes or, in the absence of diagnosis, by measuring if HbA1c ≥ 6.5% or FBG ≥ 126 mg/dL. Prediabetes was defined as 5.7% ≤ HbA1c ≤ 6.4% or 100 mg/dL ≤ FBG ≤ 125 mg/dL. Occurrence of a 90-day periprosthetic joint infection and wound complications was noted. RESULTS: A total of 1461 patients were included in the study. The prevalence of diabetes was 20.6%; 178 patients (59.1%) had diagnosed diabetes, and 123 patients (40.9%) had undiagnosed diabetes. Prediabetes was identified in 559 patients (38.3%), resulting in a combined total of 860 (58.9%) patients with diabetes and prediabetes. Total diabetic rates were significantly higher in patients aged >65 years, of nonwhite ethnicity, and undergoing total knee arthroplasty. No significant differences in periprosthetic joint infection and wound complications were observed while comparing patients with diagnosed and undiagnosed diabetes. CONCLUSION: A significant proportion of patients with undiagnosed diabetes and prediabetes were identified. Preadmission testing provides an opportunity to identify and address this condition, potentially reducing short-term arthroplasty-related complications and avoiding long-term systemic diabetic complications. We strongly recommend universal glycemic screening to all elective arthroplasty patients.
BACKGROUND:Diabetes is highly prevalent in patients with osteoarthritis before total joint arthroplasty and presents a higher risk of adverse postoperative outcomes. However, the rate of diabetes in this population and optimal screening strategies remain unknown. METHODS: We prospectively screened patients undergoing elective total joint arthroplasty for diabetes using glycated hemoglobin (HbA1c) and fasting blood glucose (FBG) levels. Screening was conducted within 2 time periods between 2012 and 2017. The prevalence of diabetes was assessed using a previous diagnosis of diabetes or, in the absence of diagnosis, by measuring if HbA1c ≥ 6.5% or FBG ≥ 126 mg/dL. Prediabetes was defined as 5.7% ≤ HbA1c ≤ 6.4% or 100 mg/dL ≤ FBG ≤ 125 mg/dL. Occurrence of a 90-day periprosthetic joint infection and wound complications was noted. RESULTS: A total of 1461 patients were included in the study. The prevalence of diabetes was 20.6%; 178 patients (59.1%) had diagnosed diabetes, and 123 patients (40.9%) had undiagnosed diabetes. Prediabetes was identified in 559 patients (38.3%), resulting in a combined total of 860 (58.9%) patients with diabetes and prediabetes. Total diabetic rates were significantly higher in patients aged >65 years, of nonwhite ethnicity, and undergoing total knee arthroplasty. No significant differences in periprosthetic joint infection and wound complications were observed while comparing patients with diagnosed and undiagnosed diabetes. CONCLUSION: A significant proportion of patients with undiagnosed diabetes and prediabetes were identified. Preadmission testing provides an opportunity to identify and address this condition, potentially reducing short-term arthroplasty-related complications and avoiding long-term systemic diabetic complications. We strongly recommend universal glycemic screening to all elective arthroplasty patients.
Authors: Aoife MacMahon; Sandesh S Rao; Yash P Chaudhry; Syed A Hasan; Jeremy A Epstein; Vishal Hegde; Daniel J Valaik; Julius K Oni; Robert S Sterling; Harpal S Khanuja Journal: HSS J Date: 2021-07-30
Authors: Raveesh D Richard; Greg E Gaski; Hassan Farooq; Daniel J Wagner; Todd O McKinley; Roman M Natoli Journal: J Clin Orthop Trauma Date: 2022-06-25
Authors: Ryan Howard; Lia Delaney; Amy M Kilbourne; Kelley M Kidwell; Shawna Smith; Michael Englesbe; Justin Dimick; Dana Telem Journal: JAMA Netw Open Date: 2021-05-03