title: Postoperative hyperglycaemia control reduces postoperative complications in patients subject to total knee arthroplasty.
abstract: BACKGROUND
  The aim of our study was the early detection and treatment of patients with unknown alterations of the hydrocarbon metabolism subject to total knee arthroplasty in order to reduce the incidence of postoperative complications.
  
  
  METHODS
  Patients were classified as non-diabetic patients (group 1), diabetic patients (group 2) and patients with stress hyperglycaemia (group 3). The last two groups were recommended assessment by a primary care physician (PCP). After one year follow-up the groups were compared with respect to incidence of postoperative complications. The groups were also compared regarding the decrease or increase of HbA1c levels with the incidence of complications.
  
  
  RESULTS
  Of the 228 patients, 116 (50%) were included in group 1, 40 (17.5%) in group 2 and 72 (31.6%) in group 3. Patients that consulted their PCP presented lower medical complication rates than those who did not (9.2% vs. 26.4%, P=0.020). Not being attended by a PCP was an independent predictive factor of medical complication (odds ratio (OR): 21.3; 95% confidence interval (95% CI): 4.6-98.5), surgical site infection (OR: 4.1; 95% CI: 1.1-15.0) and mechanical complication (OR: 5.0; 95% CI: 1.3-18.8). A decrease of HbA1c value was related to less medical systemic complications (7.3% vs. 24.2%, P=0.035).
  
  
  CONCLUSIONS
  Patients with hyperglycaemia during the postoperative total knee arthroplasty period, who are controlled by the PCP present lower incidence of complications. Decrease of HbA1c value during postoperative total knee arthroplasty period leads to a lower rate of medical complications.
authors.affiliation: Trauma and Orthopaedics Department, Hospital Clinic, Barcelona, Spain. Electronic address: diego_reategui@hotmail.com.
authors.forename: Diego
authors.initials: D
authors.lastname: Reátegui
authors.affiliation: Trauma and Orthopaedics Department, Hospital Clinic, Barcelona, Spain.
authors.forename: Eduard
authors.initials: E
authors.lastname: Tornero
authors.affiliation: Knee Unit, Trauma and Orthopaedics Department, Hospital Clinic, Barcelona, Spain.
authors.forename: Dragos
authors.initials: D
authors.lastname: Popescu
authors.affiliation: Knee Unit, Trauma and Orthopaedics Department, Hospital Clinic, Barcelona, Spain.
authors.forename: Sergi
authors.initials: S
authors.lastname: Sastre
authors.affiliation: Internal Medicine Department, Dermatology and Medicine Institute, Hospital Clinic, Barcelona, Spain.
authors.forename: Miquel
authors.initials: M
authors.lastname: Camafort
authors.affiliation: Nursery Knee Unit, Trauma and Orthopaedics Department, Hospital Clinic, Barcelona, Spain.
authors.forename: Gracia
authors.initials: G
authors.lastname: Gines
authors.affiliation: Trauma and Orthopaedics Department, Hospital Clinic, Barcelona, Spain.
authors.forename: Andrés
authors.initials: A
authors.lastname: Combalía
authors.affiliation: Knee Unit, Trauma and Orthopaedics Department, Hospital Clinic, Barcelona, Spain.
authors.forename: Luis
authors.initials: L
authors.lastname: Lozano
mesh_terms: D000368:Aged; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D048909:Diabetes Complications / Q000150:complications*; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000150:complications / Q000378:metabolism / Q000601:surgery*; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D011320:Primary Health Care; D011446:Prospective Studies
keywords: Complications; Diabetes; Glycated haemoglobin; Hyperglycaemia; Primary care physician; Total knee arthroplasty