Universal haemoglobin A1c screening reveals high prevalence of dysglycaemia in patients undergoing total knee arthroplasty

Abstract

Introduction: Diabetes mellitus is an established modifiable risk factor for periprosthetic joint infection (PJI). Haemoglobin A1c (HbA1c) is a glycaemic marker that correlates with diabetic complications and PJI. As diabetes and prediabetes are frequently asymptomatic, and there is increasing evidence to suggest a correlation between dysglycaemia and osteoarthritis, it is reasonable to provide HbA1c screening before total knee arthroplasty (TKA). The aim of the present study was to determine the prevalence of dysglycaemia in patients who underwent TKA and investigate whether HbA1c screening and optimisation of glycaemic control before TKA affects the incidence of PJI after TKA.

Methods: Patients who underwent primary TKA before and after routine HbA1c screening was introduced in our unit were reviewed. Prediabetes and diabetes were defined according to the American Diabetes Association. Patients with HbA1c ≥7.5% were referred to an endocrinologist for optimisation of glycaemic control before TKA. The incidence PJI, defined according to the Musculoskeletal Infection Society criteria, was recorded.

Results: A total of 729 patients (934 knees) had HbA1c screening before TKA. Of them, 17 (2.3%) and 184 (25.2%) patients had known prediabetes and diabetes, respectively, and 265 (36.4%) and 12 (1.6%) had undiagnosed prediabetes and diabetes, respectively. The incidence of PJI was significantly lower in all patients who received HbA1c screening compared with those who did not (0.2% vs 1.02%, P=0.027).

Conclusion: Screening for HbA1c before TKA provides a cost-effective opportunity to identify undiagnosed dysglycaemia. Patients identified as having dysglycaemia receive modified treatment, significantly reducing the rate of PJI when compared with historical controls.

引言：糖尿病是關節假體周圍感染（PJI）的既定可改變危險因子。血紅蛋白A1c是與糖尿病併發症和PJI相關的血糖標記。由於糖尿病和糖尿病前期通常無症狀，並且越來越多證據表明血糖異常與骨關節炎相關，因此在全膝關節置換術（TKA）前進行血紅蛋白A1c篩查是合理的。本研究旨在確定接受TKA的患者的血糖異常現患率，並檢視TKA前接受血紅蛋白A1c篩查和優化血糖控制是否影響TKA後的PJI現患率。 方法：對在本院進行常規血紅蛋白A1c篩查前後接受原發性TKA的患者進行回顧，並根據美國糖尿病協會界定糖尿病前期和糖尿病。在接受TKA前將血紅蛋白A1c 7.5%或以上患者轉介至內分泌專科優化血糖控制。根據美國肌肉骨骼感染學會標準記錄PJI現患率。 結果：729名患者（膝934例）在TKA前接受血紅蛋白A1c篩查，17名（2.3%）和184名（25.2%）患者分別患有糖尿病前期和糖尿病，265名（36.4%）和12名（1.6%）患者未被診斷為糖尿病前期和糖尿病。與未接受血紅蛋白A1c篩查的患者相比，接受血紅蛋白A1c篩查患者的PJI現患率均顯著較低（0.2%比1.02%，P=0.027）。 結論：在TKA前進行血紅蛋白A1c篩查是經濟且有效鑑定未診斷血糖異常的方法。與歷史對照組相比，被確定患有血糖異常的患者接受改良治療可顯著降低PJI現患率。