Department of Orthopedics and Traumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey.
Department of Orthopedics and Traumatology, Istanbul Medipol University Faculty of Medicine, Istanbul, Turkey.
Acta Orthop Traumatol Turc. 2023 Sep;57(5):289-293. doi: 10.5152/j.aott.2023.23037.
The optimal glycemic control marker before total hip or knee arthroplasty remains inconclusive. Hemoglobin A1c (HbA1c) is widely used, while fructosamine may be valuable for predicting periprosthetic joint infection (PJI). Fructosamine levels can be affected by serum albumin levels; albumin-corrected fructosamine (AlbF) can be calculated to overcome this issue. The objective of this study was to evaluate the predictive value of different markers for complications after primary total hip or knee arthroplasty.
This prospective cohort study included 304 patients (mean age: 65 years [range, 16-85), mean follow-up: 32 months (range, 12-49)] who underwent primary total hip or knee arthroplasty between 2018 and 2021. Of them, 156 patients had diabetes. Mean HbA1c was 6.5% (range, 4.8%-13%), fructosamine 244 µmol/L (range, 98-566 µmol/L), and AlbF 632 (range, 238-2308). Patients who did and did not have diabetes were matched 1 : 1. Hemoglobin A1c 7% and fructosamine 292 µmol/L were used as cutoff. Complications were documented. Glycemic markers were compared using logistic regression analyses, with a special focus on PJI.
In the logistic regression analyses, HbA1c was strongly associated with total complications [adjusted odds ratio (OR): 3.61; 95% CI, 1.65-7.91, P = .001], while fructosamine was associated with PJI (adjusted OR: 13.68; 95% CI, 1.39-134.89, P = .025). Albumin-corrected fructosamine did not show any additional benefits.
Preoperative assessment before total hip or knee arthroplasty must not focus on a single marker; HbA1c is a good predictor of total complications, while fructosamine is a better predictor of PJI. To the best of our knowledge, in its first orthopedic study, AlbF did not show any advantages.
Level II, Prognostic Study.
全髋关节或全膝关节置换术前的最佳血糖控制标志物仍不确定。糖化血红蛋白（HbA1c）被广泛应用，而果糖胺可能对预测假体周围关节感染（PJI）有价值。果糖胺水平可受血清白蛋白水平影响；白蛋白校正果糖胺（AlbF）可用于计算以克服此问题。本研究旨在评估不同标志物对初次全髋关节或全膝关节置换术后并发症的预测价值。
本前瞻性队列研究纳入了 2018 年至 2021 年期间行初次全髋关节或全膝关节置换术的 304 例患者（平均年龄：65 岁[范围：16-85]，平均随访：32 个月[范围：12-49]），其中 156 例患者患有糖尿病。平均 HbA1c 为 6.5%（范围：4.8%-13%），果糖胺 244µmol/L（范围：98-566µmol/L），AlbF 为 632µmol/L（范围：238-2308µmol/L）。糖尿病患者与非糖尿病患者按 1：1 匹配。将 HbA1c 7%和果糖胺 292µmol/L 作为截断值。记录并发症。使用逻辑回归分析比较血糖标志物，特别关注 PJI。
在逻辑回归分析中，HbA1c 与总并发症密切相关（调整后的优势比[OR]：3.61；95%置信区间[CI]：1.65-7.91，P=.001），而果糖胺与 PJI 相关（调整后的 OR：13.68；95%CI：1.39-134.89，P=.025）。白蛋白校正果糖胺未显示出任何额外益处。
全髋关节或全膝关节置换术前评估不应仅关注单一标志物；HbA1c 是总并发症的良好预测指标，而果糖胺是 PJI 的更好预测指标。据我们所知，在其第一项骨科研究中，AlbF 并未显示出任何优势。
二级，预后研究。
