Department of Orthopaedics and Traumatology, Queen Mary Hospital, Hong Kong.
Department of Medicine, Queen Mary Hospital, Hong Kong.
Hong Kong Med J. 2020 Aug;26(4):304-310. doi: 10.12809/hkmj208459. Epub 2020 Aug 7.
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.
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.
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).
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.
糖尿病是人工关节置换术后感染（PJI）的一个已确定的可改变的危险因素。糖化血红蛋白（HbA1c）是一种与糖尿病并发症和 PJI 相关的血糖标志物。由于糖尿病和糖尿病前期通常没有症状，而且越来越多的证据表明血糖异常与骨关节炎之间存在相关性，因此在全膝关节置换术（TKA）前进行 HbA1c 筛查是合理的。本研究旨在确定接受 TKA 的患者中血糖异常的患病率，并探讨 TKA 前 HbA1c 筛查和血糖控制的优化是否会影响 TKA 后 PJI 的发生率。
回顾了在我们单位引入常规 HbA1c 筛查前后接受初次 TKA 的患者。根据美国糖尿病协会的标准，将糖尿病前期和糖尿病定义为 HbA1c≥7.5%的患者转介给内分泌科医生进行 TKA 前血糖控制的优化。根据肌肉骨骼感染学会的标准，记录 PJI 的发生率。
共有 729 例患者（934 膝）接受了 TKA 前的 HbA1c 筛查。其中，17 例（2.3%）和 184 例（25.2%）患者分别患有已知的糖尿病前期和糖尿病，265 例（36.4%）和 12 例（1.6%）患者分别患有未确诊的糖尿病前期和糖尿病。与未接受 HbA1c 筛查的患者相比，所有接受 HbA1c 筛查的患者的 PJI 发生率显著降低（0.2%比 1.02%，P=0.027）。
在 TKA 前进行 HbA1c 筛查可提供一种具有成本效益的机会来发现未确诊的血糖异常。发现血糖异常的患者接受了改良治疗，与历史对照相比，显著降低了 PJI 的发生率。
