title: Relations between long-term glycemic control and postoperative wound and infectious complications after total knee arthroplasty in type 2 diabetics.
abstract: BACKGROUND
  The authors examined whether poor preoperative glucose control, as indicated by the hemoglobin A1c (HbA1c) level of more than 8%, is associated with postoperative wound and infectious complications in diabetic patients that have undergone total knee arthroplasty (TKA).
  
  
  METHODS
  One hundred and sixty-seven TKAs performed in 115 patients with type 2 diabetes mellitus, from January 2001 through March 2007, were retrospectively reviewed. Logistic regression was used to identify the variables that had a significant effect on the risk of wound complications or early deep infection. The variables considered were age, gender, body mass index, comorbidities, operation time, antibiotic-impregnated cement use, amount of blood transfusion, close suction drain use, duration of diabetes, method of diabetes treatment, diabetes complications, and preoperative HbA1c level.
  
  
  RESULTS
  The overall incidence of wound complications was 6.6% (n = 11) and there were seven cases (4.2%) of early postoperative deep infection. Logistic regression revealed that the independent risk factors of wound complications were preoperative HbA1C ≥ 8% (odds ratio [OR], 6.07; 95% confidence interval [CI], 1.12 to 33.0) and operation time (OR, 1.01; 95% CI, 1.00 to 1.03). No variable examined was found to be significantly associated with the risk of early postoperative deep infection.
  
  
  CONCLUSIONS
  Poorly controlled hyperglycemia before surgery may increase the incidence of wound complications among diabetic patients after TKA.
authors.affiliation: Department of Orthopedic Surgery, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea.
authors.forename: Hyuk-Soo
authors.initials: HS
authors.lastname: Han
authors.forename: Seung-Baik
authors.initials: SB
authors.lastname: Kang
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D001786:Blood Glucose / Q000378:metabolism; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy / Q000378:metabolism*; D005260:Female; D005947:Glucose / Q000378:metabolism*; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D015994:Incidence; D007328:Insulin / Q000627:therapeutic use; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000378:metabolism*
chemical_list: D001786:Blood Glucose; D005947:Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; C517652:hemoglobin A1c protein, human
keywords: Early deep infection; Total knee replacements; Type 2 diabetes mellitus; Wound complication