Preoperative Glycemic Control Predicts Perioperative Serum Glucose Levels in Patients Undergoing Total Joint Arthroplasty

J Arthroplasty. 2018 Jul;33(7S):S76-S80. doi: 10.1016/j.arth.2018.02.071. Epub 2018 Feb 26.


Background: Diabetic patients undergoing total joint arthroplasty (TJA) with postoperative hyperglycemia >200 mg/dL have increased the risk of prosthetic joint infection (PJI). We investigated the correlation between preoperative hemoglobin A1c (A1c) and postoperative hyperglycemia in diabetic patients undergoing TJA.

Methods: A retrospective review of 773 diabetic patients undergoing TJA was conducted. A Youden's J computational analysis determined the A1c where postoperative glucose levels >200 mg/dL were statistically more likely. Patients were then stratified into 3 groups: A1c <7%, A1c 7.0-8.0%, and A1c >8.0%. Outcomes included the highest postoperative in-hospital serum glucose level and PJI.

Results: We determined an A1c >7.45% resulted in a greater chance of postoperative hyperglycemia >200 mg/dL. Average postoperative serum glucose increased with A1c (A1c < 7 = 167 mg/dL, A1c 7.0-8.0 = 240 mg/dL, and A1c > 8 = 276 mg/dL, P < .0001). PJI did not statistically increase with A1c (2.25%, 1.99%, and 4.55%, respectively, P = .4319).

Conclusion: Preoperative hemoglobin A1c levels correlate with postoperative glucose levels. We recommend using an A1c cutoff of 7.45% for patients undergoing TJA and suggest that caution should be exercised in patients with elevated A1c levels undergoing TJA.

Keywords: diabetes mellitus; glucose; hemoglobin A1c; prosthetic joint infection; total joint arthroplasty.

MeSH terms

  • Adult
  • Aged
  • Arthroplasty, Replacement, Hip / adverse effects*
  • Arthroplasty, Replacement, Knee / adverse effects*
  • Blood Glucose / analysis*
  • Diabetes Complications / surgery*
  • Diabetes Mellitus
  • Female
  • Glycated Hemoglobin / analysis
  • Humans
  • Hyperglycemia / complications
  • Middle Aged
  • Postoperative Period
  • Prosthesis-Related Infections / blood*
  • Prosthesis-Related Infections / diagnosis*
  • ROC Curve
  • Retrospective Studies
  • Risk
  • Software


  • Blood Glucose
  • Glycated Hemoglobin A