title: Do Pre-Operative Glycated Hemoglobin Levels Correlate with the Incidence of Revision in Diabetic Patients that Undergo Total Knee Arthroplasty?
abstract: The purpose of this study was to: 1) determine the incidence of revision total knee arthroplasty (TKA); 2) correlate the percent of glycated hemoglobin with incidence of revision; and 3) determine the cause of revision in diabetic patients stratified by a glycated hemoglobin level.
  
  
  
  We analyzed 424,107 patients from a national private payer database from 2007 to 2015 to determine who had diabetes and underwent TKA. We determined the incidence of revision TKA in the overall cohort and stratified it by glycated hemoglobin levels. Correlation analysis between the levels of glycated hemoglobin and the incidence of revision TKA was performed. We performed descriptive statistics of the underlying cause of revision TKA in both the overall and stratified cohorts.
  
  
  
  There was a 3.2% incidence of revision in the overall cohort. When stratified by glycated hemoglobin levels, the cohort in the 6.6 to 7.0% category had the lowest incidence of revision (2.9%). The cohorts in the 8.6 to 9% glycated hemoglobin category had the highest revision rate (4.7%). There was a significantly positive correlation between rate of revision and ascending glycated hemoglobin levels, and a significantly negative correlation between descending glycated hemoglobin levels and revision incidence. The most common cause of revision was infection in the overall and stratified groups.
  
  
  
  Sub-optimal glycated hemoglobin levels in diabetic patients correlated with increased revision rates in those who underwent TKA. Management of diabetics should be optimized before undergoing TKA to minimize revision surgery risk.
authors.affiliation: Holy Cross Orthopedic Institute Fort Lauderdale, Florida.
authors.forename: Martin
authors.initials: M
authors.lastname: Roche
authors.affiliation: Holy Cross Orthopedic Institute Fort Lauderdale, Florida.
authors.forename: Tsun Yee
authors.initials: TY
authors.lastname: Law
authors.affiliation: Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Morad
authors.initials: M
authors.lastname: Chughtai
authors.affiliation: Department of Orthopaedic Surgery, University of Mississippi, Jackson, Mississippi.
authors.forename: Randa K
authors.initials: RK
authors.lastname: Elmallah
authors.affiliation: University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Zachary
authors.initials: Z
authors.lastname: Hubbard
authors.affiliation: Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Anton
authors.initials: A
authors.lastname: Khlopas
authors.affiliation: Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Michael
authors.initials: MA
authors.lastname: Mont
mesh_terms: D019645:Arthroplasty, Replacement, Knee; D003920:Diabetes Mellitus; D006442:Glycated Hemoglobin / Q000032:analysis*; D006801:Humans; D015994:Incidence; D011237:Predictive Value of Tests; D012086:Reoperation; D012189:Retrospective Studies
chemical_list: D006442:Glycated Hemoglobin