Department of Joint Surgery, Lianyungang Clinical College of Nanjing Medical University, Lianyungang, China.
Department of Joint Surgery, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, China.
J Coll Physicians Surg Pak. 2024 Sep;34(9):1073-1078. doi: 10.29271/jcpsp.2024.09.1073.
To establish an optimal preoperative HbA1c threshold that enhances surgical outcomes and minimises postoperative complications in diabetic patients undergoing elective total knee arthroplasty (TKA).
Prospective cohort study. Place and Duration of the Study: Department of Orthopaedics, First People's Hospital of Lianyungang, China, from January 2021 to March 2024.
A total of 152 diabetic patients scheduled for elective TKA were included. Data on preoperative HbA1c levels were collected and analysed to assess their impact on postoperative outcomes using the Oxford Knee Score (OKS). Patients were divided into groups based on HbA1c levels and compared for functional and pain recovery one year postoperatively. Statistical analyses included binary and multivariate logistic regression, with an emphasis on the minimum clinically important difference for OKS.
Patients with a preoperative HbA1c below 7.35mmol/L exhibited significantly better functional and pain recovery outcomes at one-year post-TKA. The receiver operating characteristic curve (ROC) analysis confirmed the predictive power of HbA1c, with an Area Under the Curve of 0.734 for functional improvement and 0.721 for pain improvement.
The study identifies 7.35mmol/L as the optimal preoperative HbA1c threshold for diabetic patients undergoing elective TKA, with lower levels associated with improved functional and pain outcomes. Maintaining HbA1c below this level preoperatively can significantly enhance postoperative recovery and patient satisfaction.
Diabetes mellitus, Total knee arthroplasty, Haemoglobin A1c, Oxford knee score.
确定术前糖化血红蛋白（HbA1c）最佳阈值，以改善行择期全膝关节置换术（TKA）的糖尿病患者的手术效果并减少术后并发症。
前瞻性队列研究。
中国连云港市第一人民医院骨科，2021 年 1 月至 2024 年 3 月。
共纳入 152 例行择期 TKA 的糖尿病患者。收集术前 HbA1c 水平数据，并使用牛津膝关节评分（OKS）评估其对术后结果的影响。根据 HbA1c 水平将患者分组，并在术后一年比较其功能和疼痛恢复情况。统计分析包括二项和多变量逻辑回归，重点关注 OKS 的最小临床重要差异。
术前 HbA1c 水平低于 7.35mmol/L 的患者在 TKA 后一年时功能和疼痛恢复情况显著更好。受试者工作特征曲线（ROC）分析证实了 HbA1c 的预测能力，其在功能改善方面的曲线下面积（AUC）为 0.734，在疼痛改善方面的 AUC 为 0.721。
本研究确定 7.35mmol/L 为行择期 TKA 的糖尿病患者的最佳术前 HbA1c 阈值，较低的 HbA1c 水平与改善的功能和疼痛结果相关。术前将 HbA1c 控制在此水平以下可显著促进术后恢复和提高患者满意度。
糖尿病，全膝关节置换术，糖化血红蛋白，牛津膝关节评分。
