Is hemoglobin A1c and perioperative hyperglycemia predictive of periprosthetic joint infection following total joint arthroplasty?: A systematic review and meta-analysis

Objective:This meta-analysis aims to determine whether hemoglobin A1c (HbA1c) and perioperative hyperglycemia are associated with the increased risk of periprosthetic joint infection following total knee and hip arthroplasty.Methods:A systematic search is performed in Medline (1966-October 2017), PubMed (1966-October 2017), Embase (1980-October 2017), ScienceDirect (1985-October 2017), and the Cochrane Library. Only high-quality studies are selected. A meta-analysis is performed using Stata 11.0 software.Results:Six retrospective studies including 26,901 patients meet the inclusion criteria. The present meta-analysis indicates that there are significant differences between groups in terms of perioperative random blood glucose level [weighted mean difference (WMD)=2.365, 95% confidence interval (95% CI): 1.802-2.929, P=.000] and perioperative hemoglobin A1c level (WMD=3.266, 95% CI: 2.858-3.674, P=.000). No significant difference is found regarding body mass index (BMI) condition between groups (WMD=0.027, 95% CI: -0.487 to 0.541, P=.919).Conclusion:The present meta-analysis shows that high HbA1c and perioperative hyperglycemia are associated with a higher risk of periprosthetic joint infection following total joint arthroplasty. Screening of HbA1c and perioperative blood glucose is therefore an effective method to predict deep infection.