Authors (including presenting author) :
Chan WKV(1), Chan PK(1), Woo YC(2), Chiu KY(1), Yan CH(1), Fu CH(1), Cheung MH(1), Cheung YL(1)
Affiliation :
(1) Department of Orthopaedic and Traumatology, Queen Mary Hospital (2) Department of Medicine, Queen Mary Hospital
Introduction :
Peri-prosthetic joint infection (PJI) is a devastating complication after total knee arthroplasty (TKA). Diabetes and postoperative hyperglycemia is risk factor for PJI. Hemoglobin A1c (HbA1c) is a glycemic marker and correlates with diabetic complications. As dysglycemia are frequently asymptomatic, it is plausible to screen TKA patients with HbA1c.
Objectives :
We aim to evaluate results of routine HbA1c screening in identifying undiagnosed pre-diabetes and diabetes and compare prevalence of PJI with historical data.
Methodology :
Primary TKA from 2009 to May 2018 were reviewed. American Diabetes Association defined pre-diabetes and diabetes as HbA1c 5.7% to 6.4% and >=6.5% respectively. Routine HbA1c screening and Diabetes Optimization program was started in March 2017, newly diagnosed patients or HbA1c >=7.5% were referred for optimization before TKA. All PJI within the studied period were identified and defined according to Musculoskeletal Infection Society working group in 2011.
Result & Outcome :
Routine HbA1c screening and no screening group consisted of 693 TKAs (576 patients) and 2724 TKAs (1990 patients) respectively. In routine screening group, prevalence of known pre-diabetes and diabetes was 2% and 26.2% respectively, while 36.1% and 1.4% had undiagnosed pre-diabetes and diabetes. Therefore, 37.4% have undiagnosed dysglycemia undergoing TKA and the number needed to screen was 3. Overall prevalence of PJI in routine screening and no HbA1c screening group was 0.3% and 1.0% respectively and was marginally insignificant (p = 0.068). In conclusion, routine HbA1c screening in TKA patients can identify significant proportion of undiagnosed pre-diabetes and diabetes, which provides an opportunity for early treatment and prevention of hyperglycemic complications.
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