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Archives of Orthopaedic and Trauma Surgery

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27.01.2023 | Hip Arthroplasty

Preoperatively elevated HbA1c levels can meaningfully improve following total joint arthroplasty

verfasst von: Ittai Shichman, Christian T. Oakley, Jaclyn A. Konopka, Joshua C. Rozell, Ran Schwarzkopf, Claudette M. Lajam

Erschienen in: Archives of Orthopaedic and Trauma Surgery | Ausgabe 8/2023

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Abstract

Background

Prior literature has demonstrated that diabetic (DM) patients undergoing total joint arthroplasty (TJA) with elevated preoperative HbA1c scores have poorer clinical outcomes. However, no literature has reported the effect of undergoing TJA on laboratory markers of glycemic control. This study sought to evaluate effect of undergoing TJA on postoperative glycemic control and outcomes.

Methods

This retrospective study reviewed all patients with DM who underwent primary, elective TJA at our high volume orthopedic institution. Included patients had at least one HbA1c value 3 months to 2 weeks pre-surgery and 3–6 months after surgery. Changes in HbA1c from before to after surgery were calculated. Change in HbA1c greater than 1.0% was considered clinically meaningful. Change in HbA1c was analyzed and stratified into subgroups.

Results

In total, 770 primary TJA patients were included. Patients with preoperative HbA1c > 7% vs. ≤ 7% were significantly more likely to have clinically meaningful post-TJA decrease in HbA1c (24.5 vs. 2.9%, p < 0.001). Patients with preoperative HbA1c > 8 were significantly more likely to have decrease of > 2.0 compared to those with HbA1c < 8 (p < 0.001). Multivariate regression revealed that preop HbA1c > 7.0, former and current smokers, males, and African-Americans were significantly more likely to achieve clinically meaningful decrease in HbA1c. Additionally, postoperative increase in HbA1c > 1% was associated with significantly higher 90-day ED visits.

Discussion

Patients with higher preoperative HbA1c were more likely to have clinically meaningful decreases in HbA1c postoperatively. A combination of preoperative medical optimization and improvements in mobility after TJA may play a role in these changes. Those with elevated HbA1c can have meaningful improvement in HbA1c after TJA.

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Titel: Preoperatively elevated HbA1c levels can meaningfully improve following total joint arthroplasty
verfasst von: Ittai Shichman
Christian T. Oakley
Jaclyn A. Konopka
Joshua C. Rozell
Ran Schwarzkopf
Claudette M. Lajam
Publikationsdatum: 27.01.2023
Verlag: Springer Berlin Heidelberg
Erschienen in: Archives of Orthopaedic and Trauma Surgery / Ausgabe 8/2023
Print ISSN: 0936-8051
Elektronische ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-023-04765-6

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Preoperatively elevated HbA1c levels can meaningfully improve following total joint arthroplasty