Diabetes mellitus, hemoglobin A1C, and the incidence of total joint arthroplasty infection

J Arthroplasty. 2012 May;27(5):726-9.e1. doi: 10.1016/j.arth.2011.09.013. Epub 2011 Nov 4.

Abstract

Patients with diabetes have a higher incidence of infection after total joint arthroplasty (TJA) than patients without diabetes. Hemoglobin A1c (HbA1c) levels are a marker for blood glucose control in diabetic patients. A total of 3468 patients underwent 4241 primary or revision total hip arthroplasty or total knee arthroplasty at one institution. Hemoglobin A1c levels were examined to evaluate if there was a correlation between the control of HbA1c and infection after TJA. There were a total of 46 infections (28 deep and 18 superficial [9 cellulitis and 9 operative abscesses]). Twelve (3.43%) occurred in diabetic patients (n = 350; 8.3%) and 34 (0.87%) in nondiabetic patients (n = 3891; 91.7%) (P < .001). There were 9 deep (2.6%) infections in diabetic patients and 19 (0.49%) in nondiabetic patients. In noninfected, diabetic patients, HbA1c level ranged from 4.7% to 15.1% (mean, 6.92%). In infected diabetic patients, HbA1c level ranged from 5.1% to 11.7% (mean, 7.2%) (P < .445). The average HbA1c level in patients with diabetes was 6.93%. Diabetic patients have a significantly higher risk for infection after TJA. Hemoglobin A1c levels are not reliable for predicting the risk of infection after TJA.

MeSH terms

  • Arthroplasty, Replacement, Hip / statistics & numerical data*
  • Arthroplasty, Replacement, Knee / statistics & numerical data*
  • Causality
  • Cohort Studies
  • Comorbidity
  • Diabetes Mellitus / epidemiology*
  • Diabetes Mellitus / metabolism*
  • Glycated Hemoglobin A / metabolism*
  • Hip Prosthesis / adverse effects
  • Hip Prosthesis / statistics & numerical data
  • Humans
  • Incidence
  • Knee Prosthesis / adverse effects
  • Knee Prosthesis / statistics & numerical data
  • Predictive Value of Tests
  • Prosthesis-Related Infections / epidemiology*
  • Prosthesis-Related Infections / etiology
  • Reoperation
  • Risk Factors

Substances

  • Glycated Hemoglobin A
  • hemoglobin A1c protein, human