Clin Orthop Surg.  2013 Jun;5(2):118-123. 10.4055/cios.2013.5.2.118.

Relations between Long-term Glycemic Control and Postoperative Wound and Infectious Complications after Total Knee Arthroplasty in Type 2 Diabetics

Affiliations
  • 1Department of Orthopedic Surgery, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea. ossbkang@gmail.com

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 > or = 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.

Keyword

Total knee replacements; Wound complication; Early deep infection; Type 2 diabetes mellitus

MeSH Terms

Aged
Aged, 80 and over
Arthroplasty, Replacement, Knee/*adverse effects
Blood Glucose/metabolism
Diabetes Mellitus, Type 2/blood/drug therapy/*metabolism
Female
Glucose/*metabolism
Hemoglobin A, Glycosylated/metabolism
Humans
Hypoglycemic Agents/therapeutic use
Incidence
Insulin/therapeutic use
Logistic Models
Male
Middle Aged
Retrospective Studies
Surgical Wound Infection/*metabolism
Blood Glucose
Hemoglobin A, Glycosylated
Hypoglycemic Agents
Insulin
Glucose

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Reference

1. Meding JB, Reddleman K, Keating ME, et al. Total knee replacement in patients with diabetes mellitus. Clin Orthop Relat Res. 2003. (416):208–216.
Article
2. Muller LM, Gorter KJ, Hak E, et al. Increased risk of common infections in patients with type 1 and type 2 diabetes mellitus. Clin Infect Dis. 2005. 41(3):281–288.
Article
3. Golden SH, Peart-Vigilance C, Kao WH, Brancati FL. Perioperative glycemic control and the risk of infectious complications in a cohort of adults with diabetes. Diabetes Care. 1999. 22(9):1408–1414.
4. Latham R, Lancaster AD, Covington JF, Pirolo JS, Thomas CS Jr. The association of diabetes and glucose control with surgical-site infections among cardiothoracic surgery patients. Infect Control Hosp Epidemiol. 2001. 22(10):607–612.
Article
5. Brenner RE, Riemenschneider B, Blum W, et al. Defective stimulation of proliferation and collagen biosynthesis of human bone cells by serum from diabetic patients. Acta Endocrinol (Copenh). 1992. 127(6):509–514.
Article
6. Robertson HD, Polk HC Jr. The mechanism of infection in patients with diabetes mellitus: a review of leukocyte malfunction. Surgery. 1974. 75(1):123–128.
7. van den Berghe G, Wouters P, Weekers F, et al. Intensive insulin therapy in the critically ill patients. N Engl J Med. 2001. 345(19):1359–1367.
Article
8. McMurry JF Jr. Wound healing with diabetes mellitus: better glucose control for better wound healing in diabetes. Surg Clin North Am. 1984. 64(4):769–778.
Article
9. Rohlfing CL, Wiedmeyer HM, Little RR, England JD, Tennill A, Goldstein DE. Defining the relationship between plasma glucose and HbA(1c): analysis of glucose profiles and HbA(1c) in the Diabetes Control and Complications Trial. Diabetes Care. 2002. 25(2):275–278.
10. The Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med. 1993. 329(14):977–986.
11. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33): UK Prospective Diabetes Study (UKPDS) Group. Lancet. 1998. 352(9131):837–853.
12. Sacks DB, Bruns DE, Goldstein DE, Maclaren NK, McDonald JM, Parrott M. Guidelines and recommendations for laboratory analysis in the diagnosis and management of diabetes mellitus. Clin Chem. 2002. 48(3):436–472.
Article
13. Jain NB, Guller U, Pietrobon R, Bond TK, Higgins LD. Comorbidities increase complication rates in patients having arthroplasty. Clin Orthop Relat Res. 2005. (435):232–238.
Article
14. McQueen MM, Hughes SP, May P, Verity L. Cefuroxime in total joint arthroplasty: intravenous or in bone cement. J Arthroplasty. 1990. 5(2):169–172.
15. Miner AL, Losina E, Katz JN, Fossel AH, Platt R. Deep infection after total knee replacement: impact of laminar airflow systems and body exhaust suits in the modern operating room. Infect Control Hosp Epidemiol. 2007. 28(2):222–226.
Article
16. Wen CP, David Cheng TY, Tsai SP, et al. Are Asians at greater mortality risks for being overweight than Caucasians? Redefining obesity for Asians. Public Health Nutr. 2009. 12(4):497–506.
Article
17. O'Sullivan CJ, Hynes N, Mahendran B, et al. Haemoglobin A1c (HbA1C) in non-diabetic and diabetic vascular patients. Is HbA1C an independent risk factor and predictor of adverse outcome? Eur J Vasc Endovasc Surg. 2006. 32(2):188–197.
18. Bishop JR, Moul JW, Sihelnik SA, Peppas DS, Gormley TS, McLeod DG. Use of glycosylated hemoglobin to identify diabetics at high risk for penile periprosthetic infections. J Urol. 1992. 147(2):386–388.
Article
19. Lin HT, Tsai CS, Chen YL, Liang JG. Influence of diabetes mellitus on deep neck infection. J Laryngol Otol. 2006. 120(8):650–654.
Article
20. Wilson SK, Carson CC, Cleves MA, Delk JR 2nd. Quantifying risk of penile prosthesis infection with elevated glycosylated hemoglobin. J Urol. 1998. 159(5):1537–1539.
Article
21. Boltz MM, Hollenbeak CS, Julian KG, Ortenzi G, Dillon PW. Hospital costs associated with surgical site infections in general and vascular surgery patients. Surgery. 2011. 150(5):934–942.
Article
22. England SP, Stern SH, Insall JN, Windsor RE. Total knee arthroplasty in diabetes mellitus. Clin Orthop Relat Res. 1990. (260):130–134.
Article
23. Yang K, Yeo SJ, Lee BP, Lo NN. Total knee arthroplasty in diabetic patients: a study of 109 consecutive cases. J Arthroplasty. 2001. 16(1):102–106.
24. Babkin Y, Raveh D, Lifschitz M, et al. Incidence and risk factors for surgical infection after total knee replacement. Scand J Infect Dis. 2007. 39(10):890–895.
Article
25. Gaine WJ, Ramamohan NA, Hussein NA, Hullin MG, McCreath SW. Wound infection in hip and knee arthroplasty. J Bone Joint Surg Br. 2000. 82(4):561–565.
Article
26. Chiu FY, Lin CF, Chen CM, Lo WH, Chaung TY. Cefuroxime-impregnated cement at primary total knee arthroplasty in diabetes mellitus: a prospective, randomised study. J Bone Joint Surg Br. 2001. 83(5):691–695.
27. Dronge AS, Perkal MF, Kancir S, Concato J, Aslan M, Rosenthal RA. Long-term glycemic control and postoperative infectious complications. Arch Surg. 2006. 141(4):375–380.
Article
28. Furnary AP, Wu Y. Clinical effects of hyperglycemia in the cardiac surgery population: the Portland Diabetic Project. Endocr Pract. 2006. 12:Suppl 3. 22–26.
Article
29. Pozzilli P, Leslie RD. Infections and diabetes: mechanisms and prospects for prevention. Diabet Med. 1994. 11(10):935–941.
Article
30. Tsukayama DT, Goldberg VM, Kyle R. Diagnosis and management of infection after total knee arthroplasty. J Bone Joint Surg Am. 2003. 85:Suppl 1. S75–S80.
Article
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