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

• Han HS
• Kang SB

• KMID: 1705532
• DOI: http://doi.org/10.4055/cios.2013.5.2.118

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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