Tarabichi Saad, Abe Elizabeth A, Olin Brooke, Lizcano Juan D, Goh Graham S, Mu Wenbo, Hozack William J, Cao Li, Parvizi Javad, Courtney P Maxwell
Department of Orthopaedic Surgery, Mayo Clinic Arizona, Phoenix, Arizona.
Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania.
J Arthroplasty. 2025 Sep;40(9S1):S190-S195. doi: 10.1016/j.arth.2025.04.061. Epub 2025 May 6.
Hemoglobin A1c (HbA1c) has long been the standard for measuring glycemic control; however, it may not be the ideal test to predict complications following total hip arthroplasty (THA) and total knee arthroplasty (TKA). While HbA1c measures glycemic control over three months, other markers such as fructosamine (seven to 21 days) and glycated albumin (GA) (14 to 21 days) may be more accurate predictors. The purpose of this study was to assess the utility of GA in predicting complications in patients undergoing primary THA and TKA.
This prospective study enrolled 1,020 patients (633 TKA, 387 THA) at two institutions. The mean age of our cohort was 64 years, and 631 (61.8%) patients were women. There were 131 (12.8%) patients who had a history of type 2 diabetes mellitus. The HbA1c, fructosamine, and GA were measured preoperatively using standardized assays. The HbA1c cutoff of 7.7%, fructosamine cutoff of 270 mmol/L, and GA cutoff of 17.1% were used to define poor glycemic control. The 90-day complications in patients above the threshold for each marker were identified and compared with those below it. Multivariate regressions were utilized to assess the predictive value of each test.
The HbA1c and GA were found to have the strongest correlation with one another (r = 0.63), followed by fructosamine/GA (r = 0.41) and ractopamine/HbA1c (r = 0.23). Upon regression analysis, GA ≥ 17.1% (odds ratio [OR], 4.8 [95% CI (confidence interval), 1.4 to 15.7]; P = 0.011) was identified as an independent risk factor for 90-day complications, while fructosamine (OR, 0.63 [95% CI, 0.13 to 2.13]; P = 0.51), and HbA1c (OR, 1.18 [95% CI, 0.24 to 4.97]; P = 0.83) were not.
The results of our prospective study suggest that GA may more accurately predict short-term (90-day) complications in patients undergoing THA and TKA, when compared to fructosamine and HbA1c. Longer follow-up time is necessary in order to identify the optimal GA cutoff for use in this setting and to determine whether any correlation exists between elevated GA levels and periprosthetic joint infection.
长期以来，糖化血红蛋白（HbA1c）一直是衡量血糖控制的标准；然而，它可能并非预测全髋关节置换术（THA）和全膝关节置换术（TKA）后并发症的理想检测指标。虽然HbA1c可衡量三个月内的血糖控制情况，但其他指标，如糖化血清蛋白（果糖胺，反映7至21天血糖水平）和糖化白蛋白（GA，反映14至21天血糖水平）可能是更准确的预测指标。本研究旨在评估GA在预测初次行THA和TKA患者并发症方面的效用。
这项前瞻性研究在两家机构纳入了1020例患者（633例行TKA，387例行THA）。我们队列的平均年龄为64岁，631例（61.8%）为女性。有131例（12.8%）患者有2型糖尿病病史。术前采用标准化检测方法测定HbA1c、果糖胺和GA。HbA1c临界值7.7%、果糖胺临界值270 mmol/L和GA临界值17.1%用于定义血糖控制不佳。确定每个指标高于阈值的患者的90天并发症，并与低于阈值的患者进行比较。采用多因素回归分析评估每项检测的预测价值。
发现HbA1c与GA之间的相关性最强（r = 0.63），其次是果糖胺/GA（r = 0.41）和糖化血红蛋白/HbA1c（r = 0.23）。经回归分析，GA≥17.1%（比值比[OR]，4.8[95%置信区间（CI），1.4至15.7]；P = 0.011）被确定为90天并发症的独立危险因素，而果糖胺（OR，0.63[95%CI，0.13至2.13]；P = 0.51）和HbA1c（OR，1.18[95%CI，0.24至4.97]；P = 0.83）则不是。
我们前瞻性研究的结果表明，与果糖胺和HbA1c相比，GA可能更准确地预测行THA和TKA患者的短期（90天）并发症。为了确定在此情况下使用的最佳GA临界值，并确定GA水平升高与假体周围关节感染之间是否存在任何相关性，需要更长的随访时间。
