Abstract
Introduction
There is a paucity of studies analyzing the rates of revision total knee arthroplasty in diabetic patients stratified by glycated hemoglobin levels. The purpose of this study was to: 1) determine the incidence of revision TKA; 2) correlate the percent of glycated hemoglobin with incidence of revision; and 3) determine the cause of revision in diabetic patients stratified by glycated hemoglobin level.
Methods
We utilized a national private payer dataset within the PearlDiver database from 2007 to 2015 quarter 1 to determine who had diabetes and underwent TKA. There were 424,107 patients who were included in the analysis. We determined the incidence of revision TKA in the overall cohort, in addition to stratifying the incidence by glycated hemoglobin levels. To determine the effect of glycated hemoglobin levels on revision TKA rate, we performed a correlation analysis between the level of glycated hemoglobin and the incidence of revision TKA. We performed descriptive statistics of the underlying cause of revision TKA in both the overall and stratified cohorts
Results
There was a 3.2% incidence of revision in the overall cohort. When stratified by glycated hemoglobin levels, the cohort in the 6.6 to 7.0% category had the lowest incidence of revision (2.9%). The cohorts in the 8.6 to 9%, 5.1 to 5.5%, and 4.6 to 5%, glycated hemoglobin categories had the highest revision rates of 3.7, 3.7 and 4.7%, respectively. There was a significantly positive correlation between rate of revision and ascending glycated hemoglobin levels, and significantly negative correlation between descending glycated hemoglobin levels and revision incidence. The most common cause of revision was infection in the overall and stratified groups.
Conclusion
Sub-optimal glycated hemoglobin levels in diabetic patients correlated with increase revision rates in those who underwent TKA. This may imply that management of blood glucose levels should be optimized before undergoing total knee arthroplasty to minimize revision surgery risk.
