Outcomes of shoulder arthroplasty in diabetic patients as assessed by peri-operative A1C
- 104 Downloads
Although diabetes mellitus (DM) has an adverse effect on complication rates in orthopaedic surgery, neither the effect of DM nor the association between haemoglobin A1C (HbA1C) and outcomes after shoulder arthroplasty (SA) has been studied.
A retrospective review of 406 SAs (70 HAs, 188 total shoulder arthroplasties [TSAs], 148 reverse total shoulder arthroplasties [RSAs]) with HbA1Cs within 90 days of surgery was conducted. The average age was 70 years (range 27–97) and 55% were female. The average peri-operative HbA1C was 6.4% (range 4.7–9.8%), with 104 (26%) having a HbA1C of 7.0% or greater. Kaplan-Meier curves were constructed to determine complication, re-operation, and revision rates at two, five and ten years post-operatively.
At mean follow-up of four years, 58 (16.5%) SAs were associated with post-operative complications including six (1.5%) infections. Kaplan-Meier two and five year survivorship free of any complication was 87.3 and 82.6% and of infection was 95.8 and 90.9%, respectively. Thirty-two (7.9%) SAs required reoperation with 26 (6.4%) of these being revisions. Survivorship at two and five years post-operatively was 97.1 and 92.7% for re-operation and 98.6 and 98.2% for revision, respectively. No increased risk of complications, re-operation, revision, or infection was seen with increased HbA1C analyzed as a continuous variable (hazard ratio = 0.97–1.11, 95% CI = 0.28–3.94, p = 0.5882–0.9445) or as a dichotomous variable with a cutoff of 7.0% (hazard ratio = 1.02–1.47, 95% CI = 0.20–7.48, p = 0.3253–0.9544).
A collaborative and comprehensive approach to the pre-operative medical evaluation of patients with DM is critical, as is future investigation into alternative methods associated with outcomes after shoulder arthroplasty in patients with DM.
Level of evidence
KeywordsDiabetes Haemoglobin A1C Shoulder arthroplasty Hemiarthroplasty Total shoulder arthroplasty Reverse total shoulder arthroplasty Complications
- 6.Jain NB, Guller U, Pietrobon R, Bond TK, Higgins LD (2005) Comorbidities increase complication rates in patients having arthroplasty. Clin Orthop Relat Res 435:232–238Google Scholar
- 15.Garber AJ, Moghissi ES, Bransome ED, Clark NG, Clement S, Cobin RH, Furnary AP, Hirsch IB, Levy P, Roberts R, Van den Berghe G, Zamudio V Control ACoETFoIDM American College of Endocrinology position statement on inpatient diabetes and metabolic control. Endocr Pract 10:77–82. https://doi.org/10.4158/EP.101.77
- 16.Mraovic B, Hipszer BR, Epstein RH, Pequignot EC, Parvizi J, Joseph JI (2010) Preadmission hyperglycemia is an independent risk factor for in-hospital symptomatic pulmonary embolism after major orthopedic surgery. J Arthroplast 25:64–70. https://doi.org/10.1016/j.arth.2008.10.002 CrossRefGoogle Scholar
- 17.American Diabetes Association AD, Nowicka P, Santoro N, Liu H, Romualdo LGG, Morales MG, Otón MA, Cowie C, Rust K, Byrd-Holt D, Ziemer D, Kolm P, Weintraub W, Kumar P, Bhansali A, Ravikiran M, Selvin E, Steffes M, Ballantyne C, Hoogeveen R, Coresh J, Brancati F, Picón M, Murri M, Muñoz A, Fernández-García J, Gomez-Huelgas R, Tinahones F, Genuth S, Alberti K, Bennett P, Zhang X, Gregg E, Williamson D, Selvin E, Steffes M, Zhu H, Ackermann R, Cheng Y, Williamson D, Gregg E, Dabelea D, Mayer-Davis E, Saydah S, Ziegler A, Rewers M, Simell O, Sorensen J, Johannesen J, Pociot F, Sosenko J, Skyler J, Palmer J, Griffin S, Borch-Johnsen K, Davies M, Kahn R, Alperin P, Eddy D, Araneta M, Gandinetti A, Chang H, Hsu W, Araneta M, Kanaya A, Chiang J, Fujimoto W, Chiu M, Austin P, Manuel D, Shah B, Tu J, Erickson S, Le L, Zakharyan A, Knowler W, Barrett-Connor E, Fowler S, Tuomilehto J, Lindström J, Eriksson J, Pan X-R, Li G-W, Hu Y-H, Buchanan T, Xiang A, Peters R, Chiasson J-L, Josse R, Gomis R, Hanefeld M, Karasik A, Laakso M, Gerstein H, Yusuf S, Bosch J, Ramachandran A, Snehalatha C, Mary S, Mukesh B, Bhaskar A, Vijay V, Johnson S, Tabaei B, Herman W, Buse J, Kaufman F, Linder B, Hirst K, Ghormli LE, Willi S, Kapadia C, Zeitler P, Kester L, Hey H, Hannon T, Wu E-L, Kazzi N, Lee J, Lawrence J, Contreras R, Chen W, Sacks D, Metzger B, Lowe L, Dyer A, Metzger B, Gabbe S, Persson B, Landon M, Spong C, Thom E, Crowther C, Hiller J, Moss J, McPhee A, Jeffries W, Robinson J, Vandorsten J, Dodson W, Espeland M, Horvath K, Koch K, Jeitler K, Duran A, Sáenz S, Torrejón M, Ethridge J, Catalano P, Waters T, Hattersley A, Bruining J, Shield J, Njolstad P, Donaghue K, Kern A, Prestridge A, Waugh N, Royle P, Craigie I, Moran A, Dunitz J, Nathan B, Saeed A, Holme B, Thomas W, Moran A, Pekow P, Grover P, Onady G, Stolfi A, Moran A, Brunzell C, Cohen R, Carpenter M, Coustan D (2015) (2) Classification and diagnosis of diabetes. Diabetes care 38(Suppl):S8–S16. https://doi.org/10.2337/dc15-S005 CrossRefGoogle Scholar
- 18.Adams AL, Paxton EW, Wang JQ, Johnson ES, Bayliss EA, Ferrara A, Nakasato C, Bini SA, Namba RS (2013) Surgical outcomes of total knee replacement according to diabetes status and glycemic control, 2001 to 2009. J Bone Joint Surg Am 95:481–487. https://doi.org/10.2106/JBJS.L.00109 CrossRefPubMedGoogle Scholar
- 19.Chrastil J, Anderson MB, Stevens V, Anand R, Peters CL, Pelt CE (2015) Is hemoglobin A1c or perioperative hyperglycemia predictive of periprosthetic joint infection or death following primary total joint arthroplasty? J Arthroplast 30:1197–1202. https://doi.org/10.1016/j.arth.2015.01.040 CrossRefGoogle Scholar
- 20.Goldstein DT, Durinka JB, Martino N, Shilling JW (2013) Effect of preoperative hemoglobin A(1c) level on acute postoperative complications of total joint arthroplasty. Am J Orthop (Belle Mead, NJ) 42:E88–E90Google Scholar
- 23.Maradit Kremers H, Lewallen LW, Mabry TM, Berry DJ, Berbari EF, Osmon DR (2015) Diabetes mellitus, hyperglycemia, hemoglobin A1C and the risk of prosthetic joint infections in total hip and knee arthroplasty. J Arthroplast 30:439–443. https://doi.org/10.1016/j.arth.2014.10.009 CrossRefGoogle Scholar
- 25.Stryker LS, Abdel MP, Morrey ME, Morrow MM, Kor DJ, Morrey BF (2013) Elevated postoperative blood glucose and preoperative hemoglobin A1C are associated with increased wound complications following total joint arthroplasty. J Bone Joint Surg Am 95(808–814):S801–S802. https://doi.org/10.2106/JBJS.L.00494 CrossRefGoogle Scholar
- 26.Berry DJ, Kessler M, Morrey BF (1997) Maintaining a hip registry for 25 years. Mayo Clinic experience. Clin Orthop Relat Res 344:61–68Google Scholar
- 30.Tashjian RZ, Lilly DT, Isaacson AM, Georgopoulos CE, Bettwieser SP, Burks RT, Greis PE, Presson AP, Granger EK, Zhang Y Incidence of and risk factors for symptomatic venous thromboembolism after shoulder arthroplasty. Am J Orthop (Belle Mead, NJ) 45(6):E379–E385Google Scholar
- 31.Kallio PJ, Nolan J, Olsen AC, Breakwell S, Topp R, Pagel PS (2015) Anesthesia preoperative clinic referral for elevated Hba1c reduces complication rate in diabetic patients undergoing total joint arthroplasty. Anesthesiol Pain Med 5:e24376. https://doi.org/10.5812/aapm.5(3)2015.24376 CrossRefGoogle Scholar
- 34.Adams JE, Sperling JW, Schleck CD, Harmsen WS, Cofield RH (2007) Outcomes of shoulder arthroplasty in Olmsted County, Minnesota. Clin Orthop Relat Res 455:176–182. https://doi.org/10.1097/01.blo.0000238870.99980.64 CrossRefPubMedGoogle Scholar
- 39.Guery J, Favard L, Sirveaux F, Oudet D, Mole D, Walch G (2006) Reverse total shoulder arthroplasty<sbt aid="1113785">survivorship analysis of eighty replacements followed for five to ten years</sbt>. J Bone Joint Surg (Am) 88:1742. https://doi.org/10.2106/JBJS.E.00851 CrossRefGoogle Scholar