Sugar…Yes, Sugar…Increases Periprosthetic Infection Risk

Testing fructosamine levels (fructosamine, a glycated blood protein, is a compound which forms when glucose combines with protein in a process call glycation) may help predict increased risk of periprosthetic joint infection (PJI), according to a new study presented at the 2021 American Academy of Orthopaedics Surgeons annual meeting in San Diego, California.

In the study, “Elevated Fructosamine Levels Are Associated With Increased Risk For Periprosthetic Joint Infection,” researchers found that elevated levels of fructosamine could indicate an increased risk for periprosthetic joint infection after total hip arthroplasty.

A previous study, “Arthroplasty-Associated Infections,” also found fructosamine levels could predict adverse outcomes after total knee arthroplasty. Periprosthetic infections occur in about 1% of all total joint arthroplasties and can have devastating complications for both the patient and the surgeon.

This newest study looked specifically at fructosamine’s predictive ability in regard to both general and periprosthetic joint infection following total hip arthroplasty.

All primary total hip arthroplasty patients were evaluated for glycemic control using fructosamine and HbA1c levels prior to surgery. Adverse outcomes were assessed at a minimum of one year post surgery. Based on previous data, a fructosamine level above 293 µmol/L was used to indicate poor glycemic control.

Overall, 960 patients were included in the study. Thirty-four or 3.5% of the 960 were considered to have inadequate glycemic control based on fructosamine levels. The researchers calculated that these patients were 6.8 times more likely to develop a periprosthetic joint infection compared with the patients who had good glycemic control (8.8% vs. 1.3%; p = 0.014).

Additionally, the relationship between high fructosamine levels and increased risk for periprosthetic joint infection remained significant after adjusting for age, comorbidities, and preoperative HbA1c levels in a regression analysis (adjusted OR, 5.04, 95% CI 1.2-21.1).

The researchers wrote, “Fructosamine is a good proxy for glycemic control and elevated levels correlate with the risk for subsequent periprosthetic joint infection in patients undergoing total hip arthroplasty. A strong consideration should be given to the use of fructosamine as a glycemia screening tool in patients undergoing surgery.”