Elevated Glucose Levels in Non-Diabetic Patients = Higher PJI Risk?

While diabetic total hip arthroplasty (THA) patients are associated with higher levels of periprosthetic joint infection (PJI), does that, therefore, imply that non-diabetic patients with elevated glucose levels are also at higher risk of PJI?

A research team from Keck Medicine of USC designed a 90,830-patient study to answer that question. Their work, “Higher Blood Glucose Levels on the Day of Surgery Are Associated with an Increased Risk of Periprosthetic Joint Infection After Total Hip Arthroplasty,” appears in the December 21, 2023 edition of The Journal of Bone and Joint Surgery.

“It is well accepted that total joint arthroplasty patients with uncontrolled diabetes and diabetics with elevated perioperative glucose levels have increased wound healing problems and elevated infection rates,” co-author Jay Lieberman, M.D., chair of the Department of Orthopaedic Surgery at the Keck School of Medicine of USC and orthopaedic surgeon with Keck Medicine of USC , told OTW. “The hypothesis has been that the elevated blood glucose in some way impacts polymorphonuclear leukocyte activity. Our thought was that this could be true in other patients with elevated glucose levels.”

Nathanael Heckmann, M.D., an orthopedic surgeon with Keck Medicine of USC, was also an author and commented, “There has been no consensus on this topic because the results in the prior literature have been inconclusive. In addition, arthroplasty surgeons are focusing on medical optimization of diabetic patients. However, there are pre-diabetic patients and unrecognized diabetic patients that are at increased risk for elevated pre-operative glucose levels.”

The team evaluated 90,830 THA patients whose day-of-surgery pre-operative blood glucose levels were measured (January 1, 2016, to December 31, 2021). They evaluated the association between pre-operative blood glucose levels and 90-day PJI risk.

Dr. Heckmann told OTW, “The most important results include:

• There is an independent association between elevated pre-operative blood glucose levels and periprosthetic joint infection risk in both diabetic and non-diabetic patients undergoing a THA;
• In patients with diabetes the odds of superficial and deep wound infections were increased in patients with elevated pre-operative blood glucose levels;
• It is important to note we are not stating that a single metric be used to determine care. A global approach to medical optimization is necessary in order to balance risks and access to care.”

Dr. Lieberman added, “The influence of pre-operative and perioperative glucose levels needs further study to better identify appropriate glucose levels. In addition, there is very little data on glucose control in same day surgery patients.”