title: Diabetes mellitus, hemoglobin A1C, and the incidence of total joint arthroplasty infection.
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.
authors: Department of Orthopaedic Surgery, Lahey Clinic Medical Center, Burlington, Massachusetts 01805, USA.
authors: Richard
authors: R
authors: Iorio
authors: Kelly M
authors: KM
authors: Williams
authors: Andrew J
authors: AJ
authors: Marcantonio
authors: Lawrence M
authors: LM
authors: Specht
authors: John F
authors: JF
authors: Tilzey
authors: William L
authors: WL
authors: Healy
mesh_terms: D019644:Arthroplasty, Replacement, Hip / Q000706:statistics & numerical data*; D019645:Arthroplasty, Replacement, Knee / Q000706:statistics & numerical data*; D015984:Causality; D015331:Cohort Studies; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology* / Q000378:metabolism*; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006622:Hip Prosthesis / Q000009:adverse effects / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007720:Knee Prosthesis / Q000009:adverse effects / Q000706:statistics & numerical data; D011237:Predictive Value of Tests; D016459:Prosthesis-Related Infections / Q000453:epidemiology* / Q000209:etiology; D012086:Reoperation; D012307:Risk Factors
chemical_list: D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human