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Open Access Is hemoglobin A1c and perioperative hyperglycemia predictive of periprosthetic joint infection following total joint arthroplasty?

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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.
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Keywords: hemoglobin A1c; hyperglycemia; meta-analysis; periprosthetic joint infection; total joint arthroplasty

Document Type: Research Article

Affiliations: Department of Orthopedics, Shengjing Hospital of China Medical University, Shenyang, China.

Publication date: December 1, 2017

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