Universal haemoglobin A1c screening reveals high prevalence of dysglycaemia in patients undergoing total knee arthroplasty
| Autor: | Pk` Chan, Vincent Wk Chan, MH Cheung, Amy Cheung, Kwong Yuen Chiu, YC Woo, C. Yan, Henry Fu |
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| Rok vydání: | 2020 |
| Předmět: |
Adult
Male musculoskeletal diseases medicine.medical_specialty Prosthesis-Related Infections endocrine system diseases Total knee arthroplasty Periprosthetic Glycemic Control Osteoarthritis Asymptomatic Prediabetic State Diabetes mellitus Internal medicine Preoperative Care Diabetes Mellitus Prevalence Humans Hypoglycemic Agents Mass Screening Medicine Prediabetes Risk factor Arthroplasty Replacement Knee Glycated Hemoglobin Arthritis Infectious business.industry Incidence Incidence (epidemiology) Middle Aged Osteoarthritis Knee medicine.disease Preoperative Period Hong Kong Female medicine.symptom business |
| Zdroj: | Hong Kong Medical Journal. |
| DOI: | 10.12809/hkmj208459 |
| Popis: | Introduction Diabetes mellitus is an established modifiable risk factor for periprosthetic joint infection (PJI). Haemoglobin A1c (HbA1c) is a glycaemic marker that correlates with diabetic complications and PJI. As diabetes and prediabetes are frequently asymptomatic, and there is increasing evidence to suggest a correlation between dysglycaemia and osteoarthritis, it is reasonable to provide HbA1c screening before total knee arthroplasty (TKA). The aim of the present study was to determine the prevalence of dysglycaemia in patients who underwent TKA and investigate whether HbA1c screening and optimisation of glycaemic control before TKA affects the incidence of PJI after TKA. Methods Patients who underwent primary TKA before and after routine HbA1c screening was introduced in our unit were reviewed. Prediabetes and diabetes were defined according to the American Diabetes Association. Patients with HbA1c ≥7.5% were referred to an endocrinologist for optimisation of glycaemic control before TKA. The incidence PJI, defined according to the Musculoskeletal Infection Society criteria, was recorded. Results A total of 729 patients (934 knees) had HbA1c screening before TKA. Of them, 17 (2.3%) and 184 (25.2%) patients had known prediabetes and diabetes, respectively, and 265 (36.4%) and 12 (1.6%) had undiagnosed prediabetes and diabetes, respectively. The incidence of PJI was significantly lower in all patients who received HbA1c screening compared with those who did not (0.2% vs 1.02%, P=0.027). Conclusion Screening for HbA1c before TKA provides a cost-effective opportunity to identify undiagnosed dysglycaemia. Patients identified as having dysglycaemia receive modified treatment, significantly reducing the rate of PJI when compared with historical controls. |
| Databáze: | OpenAIRE |
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