Diabetes Mellitus and Hyperglycemia and the Risk of Aseptic Loosening in Total Joint Arthroplasty.
It is unknown to what extent diabetes mellitus modifies the long-term risk of aseptic loosening in total hip arthroplasty (THA) and total knee arthroplasty (TKA). We examined the association between diabetes mellitus, perioperative hyperglycemia, and the likelihood of revisions for aseptic loosening.



We studied 16,085 primary THA and TKA procedures performed at a large tertiary care hospital between 2002 and 2009. All blood glucose values around the time of surgery (within 1 week) were retrieved. Subsequent revision surgeries and the reasons for revision were ascertained through the institutional joint registry. Multivariate Cox models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) for aseptic loosening associated with diabetes mellitus and hyperglycemia adjusting for age, gender, body mass index, and surgery type.



A total of 2911 (18%) surgeries had a diagnosis of diabetes mellitus at the time of surgery. Glucose testing was performed at least once in 7055 (44%) procedures within ±1 week of surgery. Although diabetic patients did not experience a higher risk of revision for aseptic loosening (HR, 0.87; 95% CI, 0.55-1.38), higher preoperative glucose values on the day before surgery were significantly associated with both the overall risk of revisions (HR, 2.80; 95% CI, 1.00-7.85) and revisions for aseptic loosening (HR, 4.95; 95% CI, 1.26-19.54).



High preoperative hyperglycemia is a potential risk factor for aseptic loosening in THA and TKA.
Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota; Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota.
Hilal
H
Maradit Kremers
Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota.
Cathy D
CD
Schleck
Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota.
Eric A
EA
Lewallen
Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota.
Dirk R
DR
Larson
Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota.
Andre J
AJ
Van Wijnen
Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota.
David G
DG
Lewallen
D000328:Adult; D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D001786:Blood Glucose; D015992:Body Mass Index; D048909:Diabetes Complications / Q000097:blood / Q000150:complications*; D003920:Diabetes Mellitus / Q000097:blood / Q000601:surgery; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000150:complications* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D057234:Preoperative Period; D016016:Proportional Hazards Models; D011475:Prosthesis Failure; D012042:Registries; D012044:Regression Analysis; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D062606:Tertiary Care Centers
D001786:Blood Glucose
aseptic loosening; diabetes mellitus; hyperglycemia; total hip arthroplasty; total knee arthroplasty