Kheir Michael M, Anderson Christopher G, Chiu Yu-Fen, Carli Alberto
Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan.
Department of Orthopaedic Surgery, Virginia Commonwealth University, Richmond, Virginia.
J Arthroplasty. 2025 Apr;40(4):1005-1013. doi: 10.1016/j.arth.2024.09.043. Epub 2024 Oct 4.
Recent investigations have determined that abnormal postoperative glycemia following primary total joint arthroplasty is associated with adverse events. Our study aimed to determine if hyperglycemia and glycemic variability following aseptic revision total joint arthroplasty were associated with periprosthetic joint infection (PJI) within two years postoperatively.
A retrospective review was performed of 2,208 patients within a single institution undergoing aseptic revision total joint arthroplasty from 2012 to 2019. Postoperative glucose values were recorded. Glycemic variability was measured via three parameters: coefficient of variation, mean amplitude of glycemic excursions, and J-index. Logistic regression analyses were performed to examine associations with PJI at 90-day, 1-, and 2-year follow-up.
In revision hips, all glycemic measures were not associated with PJI at any time point in logistic regression analyses, except for the mean amplitude of glycemic excursions, which predicted PJI at one year (P = 0.045); body mass index was the only factor associated with PJI at all timepoints in all models. In revision knees, all glycemic measures were not associated with PJI at any timepoint in logistic regression analyses; however, PJI rates differed between diabetics and nondiabetics at all time points (P < 0.05).
Our findings illustrate that decreasing preoperative body mass index and postoperative glycemic variability may be critical in reducing PJI rates in revision hips. Furthermore, patients who have diabetes should be counseled that they remain at higher risk of PJI regardless of perioperative glucose control after revision knee surgery.
近期研究已确定，初次全关节置换术后异常的术后血糖与不良事件相关。我们的研究旨在确定无菌性翻修全关节置换术后的高血糖和血糖变异性是否与术后两年内的假体周围关节感染（PJI）相关。
对2012年至2019年在单一机构接受无菌性翻修全关节置换术的2208例患者进行回顾性研究。记录术后血糖值。通过三个参数测量血糖变异性：变异系数、血糖波动平均幅度和J指数。进行逻辑回归分析，以检验在90天、1年和2年随访时与PJI的相关性。
在翻修髋关节中，除血糖波动平均幅度在1年时可预测PJI外（P = 0.045），逻辑回归分析中所有血糖指标在任何时间点均与PJI无关；在所有模型中，体重指数是在所有时间点与PJI相关的唯一因素。在翻修膝关节中，逻辑回归分析中所有血糖指标在任何时间点均与PJI无关；然而，糖尿病患者和非糖尿病患者在所有时间点的PJI发生率均存在差异（P < 0.05）。
我们的研究结果表明，降低术前体重指数和术后血糖变异性可能对降低翻修髋关节的PJI发生率至关重要。此外，应告知糖尿病患者，无论翻修膝关节手术后围手术期血糖控制情况如何，他们发生PJI的风险仍然较高。
