Glycated Albumin as a Predictor of Adverse Outcomes in Patients Undergoing Primary Total Hip and Knee Arthroplasty: A Multicenter Prospective Study.

BACKGROUND

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.

METHODS

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.

RESULTS

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.

CONCLUSIONS

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.