Preoperative hyperglycemia predicts infected total knee replacement

Eur J Intern Med. 2010 Jun;21(3):196-201. doi: 10.1016/j.ejim.2010.02.006. Epub 2010 Mar 15.


Background: Diabetes increases the risk of surgical site infections. In many patients undergoing total knee replacement, however, diabetes has not been diagnosed. The purpose of this study was to analyze the applicability of preoperative screening for hyperglycemia in identifying patients predisposed to infected knee replacement.

Methods: A recent series of 1565 primary total knee replacements performed due to osteoarthritis in a specialized, publicly funded hospital for joint replacement was reviewed.

Results: Preoperative hyperglycemia was significantly associated with infected knee replacement: during the 1-year follow-up infection occurred in 0.44%, 0.93% and 2.42% of patients with preoperative plasma glucose <6.1 mmol/l (<110 mg/dl), 6.1-6.9 mmol/l (110-125 mg/dl) and > or =7.0 mmol/l (> or =126 mg/dl). In age- and gender-adjusted analysis the patients with the highest glucose levels had a 4-fold risk for infected knee replacement compared to the patients with the lowest glucose. Obesity increased the risk of infected knee replacement, but the effect of hyperglycemia on the infection rates remained significant also after adjustment for body mass index. None of the patients with normal but 2.8% of patients with increased glycosylated hemoglobin (>6.5%) experienced infected knee replacement.

Conclusion: Obesity and hyperglycemia associate with a higher risk of infected knee replacement. Preoperative screening of plasma glucose is an efficient way to identify patients in increased risk of infection following primary total knee replacement.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Arthroplasty, Replacement, Knee / statistics & numerical data*
  • Blood Glucose
  • Female
  • Glycated Hemoglobin A / metabolism
  • Humans
  • Hyperglycemia / diagnosis
  • Hyperglycemia / epidemiology*
  • Male
  • Middle Aged
  • Obesity, Abdominal / epidemiology
  • Osteoarthritis, Knee / epidemiology*
  • Osteoarthritis, Knee / surgery*
  • Predictive Value of Tests
  • Preoperative Care
  • Risk Factors
  • Surgical Wound Infection / diagnosis
  • Surgical Wound Infection / epidemiology*


  • Blood Glucose
  • Glycated Hemoglobin A