Diabetes Mellitus and Hyperglycemia and the Risk of Aseptic Loosening in Total Joint Arthroplasty

被引:41
作者
Kremers, Hilal Maradit [1 ,2 ]
Schleck, Cathy D. [1 ]
Lewallen, Eric A. [2 ]
Larson, Dirk R. [1 ]
Van Wijnen, Andre J. [2 ]
Lewallen, David G. [2 ]
机构
[1] Mayo Clin, Dept Hlth Sci Res, 200 First St SW, Rochester, MN 55905 USA
[2] Mayo Clin, Dept Orthoped Surg, Rochester, MN USA
关键词
total knee arthroplasty; total hip arthroplasty; diabetes mellitus; hyperglycemia; aseptic loosening; TOTAL KNEE ARTHROPLASTY; TOTAL HIP; GLYCEMIC CONTROL; OSTEOARTHRITIS; REPLACEMENT; REVISION; OSSEOINTEGRATION; COMPLICATIONS; IMPLANTS; SKELETON;
D O I
10.1016/j.arth.2017.02.056
中图分类号
R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学(修复外科学)];
学科分类号
摘要
Background: It is unknown to what extent diabetes mellitus modifies the long-term risk of aseptic loosening in total hip arthroplasty (THA) and total knee arthroplasty (TKA). We examined the association between diabetes mellitus, perioperative hyperglycemia, and the likelihood of revisions for aseptic loosening. Methods: We studied 16,085 primary THA and TKA procedures performed at a large tertiary care hospital between 2002 and 2009. All blood glucose values around the time of surgery (within 1 week) were retrieved. Subsequent revision surgeries and the reasons for revision were ascertained through the institutional joint registry. Multivariate Cox models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) for aseptic loosening associated with diabetes mellitus and hyperglycemia adjusting for age, gender, body mass index, and surgery type. Results: A total of 2911 (18%) surgeries had a diagnosis of diabetes mellitus at the time of surgery. Glucose testing was performed at least once in 7055 (44%) procedures within +/- 1 week of surgery. Although diabetic patients did not experience a higher risk of revision for aseptic loosening (HR, 0.87; 95% CI, 0.55-1.38), higher preoperative glucose values on the day before surgery were significantly associated with both the overall risk of revisions (HR, 2.80; 95% CI, 1.00-7.85) and revisions for aseptic loosening (HR, 4.95; 95% CI, 1.26-19.54). Conclusion: High preoperative hyperglycemia is a potential risk factor for aseptic loosening in THA and TKA. (C) 2017 Elsevier Inc. All rights reserved.
引用
收藏
页码:S251 / S253
页数:3
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