High Glycemic Variability=2x Greater Risk for Complications?

What, if any, is the association between postoperative glycemic variability and adverse outcomes following aseptic revision total hip arthroplasty and total knee arthroplasty?

New study, “Serum Glucose Variability Increases the Risk of Complications Following Aseptic Revision Hip and Knee Arthroplasty,” appears in the September 21, 2022, edition of The Journal of Bone and Joint Surgery (American).

Lead author Graham Goh, M.D., an orthopedic surgery resident at Boston University Medical Center, told OTW, “Increased glucose variability has been recognized as a risk factor for perioperative complications and infection following primary total joint arthroplasty (Shohat et al. JBJS 2018).”

“This glycemic marker has also been linked to higher rates of treatment failure and reinfection following 2-stage exchange arthroplasty for periprosthetic joint infection (Wang et al. JOA 2020). Nevertheless, current literature on the impact of higher glucose variability in revision total hip arthroplasty remains limited.”

Armed with data from the Rothman Orthopaedic Institute at Thomas Jefferson University in Philadelphia, the team reviewed information for 1,983 patients who had undergone aseptic revision total joint arthroplasty (636 knee arthroplasties and 1,347 hip arthroplasties) from 2001 to 2019.

They found that patients with high glycemic variability were at 1.7 times greater risk for 90-day complications and 2 times greater risk for periprosthetic joint infection at a minimum 1-year follow-up.

The risk of 90-day complications increased by 2.2% and the risk of periprosthetic joint infection increased by 1.8% for every percentage-point increase in COV [coefficient of variation]. Patients with higher glucose variability also had a longer length of stay. These associations were independent of age, sex, body mass index, Charlson Comorbidity Index, involved joint, operative time, history of diabetes, and mean glucose levels.

We asked if hospital should have a standardized preop period during which they monitor glucose levels and Dr. Goh said, “Our results show that there is a strong independent association between high glucose variability and an increased risk of complications after revision total hip arthroplasty. However, due to the retrospective nature of our study, we cannot make specific recommendations regarding the effectiveness of standardized glucose monitoring in the perioperative period.”

“It is encouraging to note that several clinical trials investigating the efficacy of continuous glucose monitoring devices in perioperative blood glucose monitoring following total hip arthroplasty are currently ongoing, one of which has been recently funded by the Orthopaedic Research and Education Foundation. Furthermore, even if a strong association is once again demonstrated upon completion of these prospective trials, we believe that interventional trials documenting the efficacy of reducing glucose variability in mitigating these complications need to be conducted prior to the widespread adoption of continuous glucose monitoring devices in arthroplasty care.”