Glucose! Key to Reducing TKA Complication Risk?

A team from Rothman Institute in Philadelphia and Tel Aviv University in Israel have determined that controlling postoperative glycemic variability may reduce the risk for infection and death after total joint arthroplasty (TJA).

Their work, “Increased Postoperative Glucose Variability Is Associated with Adverse Outcomes Following Total Joint Arthroplasty,” appears in the July 5, 2018 edition of The Journal of Bone and Joint Surgery.

Co-author Noam Shohat, M.D., with Rothman Institute and Tel Aviv University, told OTW, “Glycemic control throughout the perioperative period has been a focus of many recent studies since it holds the potential for reducing complication rates following TJA.”

“However, the proper marker for assessing glycemic control remains unknown.”

“Studies into the subject have produced conflicting results and traditional markers such as glycated hemoglobin and fasting glucose levels have recently been called into question. The focus on glycemic variability has gained popularity in recent years and has been studied extensively in fields outside of orthopedics, as a predictor of adverse outcomes in hospitalized patients.”

“Prior in-vivo and in-vitro studies attribute the negative effects of these fluctuations to the activation of pro-inflammatory proteins and excessive oxidative stress. As non-invasive continuous glucose monitoring devices are becoming widely available our aim was to examine the role of glycemic variability in predicting adverse outcomes following TJA.

“Higher glycemic variability was associated with increased length of stay, 90-day mortality, and joint infection; patients with high glycemic variability were two times more likely to suffer from a periprosthetic joint infection and four times more likely to die compared to patients with low glycemic variability.”

“Notably, these associations were significant even for non-diabetic patients and patients with normal postoperative glucose levels.”

“Our findings highlight the importance of fluctuations in glucose values as opposed to a single high measure in the postoperative period.”

“Controlling glycemic variability in the postoperative period may reduce the risk for infection and death. Patients with rapid swings in glucose in the immediate postoperative period should be followed more closely and might benefit from continuous glucose measuring in an effort to reduce these deleterious oscillations.”

“Future studies should examine the role of continuous glucose monitoring in a subset of patients with high glucose fluctuations.”