Abstract
Introduction
It is well established that diabetic patients undergoing total knee arthroplasty (TKA) are more susceptible to infection, problematic wound healing, and have overall higher complication rates. However there is a paucity in current literature investigating the effects of hypoglycemia on TKA. The purpose of this study was to determine the effect of hypoglycemia on TKA revision (rTKA) incidence analyzing a national private payer database for procedures performed between 2007 and 2015 Q1.
Methods
A retrospective review of a national private payer database within the PearlDiver Supercomputer application (Warsaw, IN, USA) for patients undergoing TKA with blood glucose levels ranging from 20 to 219 mg/ml, in increments of 10 mg/ml, was conducted. Patients who underwent TKA were identified by Current Procedural Terminology (CPT)-27447 and International Classification of Disease (ICD) code 81.54. Glucose ranges were identified by filtering for lab identifier values unique to the PearlDiver database. Revision TKA and causes for revision, including mechanical loosening, failure/break, periprosthetic fracture, osteolysis, infection, pain, arthrofibrosis, instability, and trauma) were identified with CPT and ICD-9 Codes. Statistical analysis of this study was primarily descriptive.
Results
Our query returned a total of 244,153 TKAs, of which 11,767 (4.8%) were revised. Most TKAs were performed with a glucose range of 70–99 mg/ml (26.3%), followed by 100–109 mg/ml (18.6%). Patients with TKAs performed with a glucose range of 20–29 mg/ml had the highest rate of revision (15.2%) (p<0.001) following the index procedure. Infection was the most common cause of revision among all studied glucose ranges (p<0.001).
Conclusion
Infection remains one of the most common causes of rTKA irrespective of glucose level. Our results suggest that hypoglycemia may increase revision rates among TKA patients. Tight glycemic control prior to and during surgery may be warranted.
