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Higher Blood Glucose Levels on Surgery Day Could Increase Infection Risk After Hip Replacement

Researchers from Keck Medicine of USC identified the blood glucose levels that signal a greater likelihood of developing periprosthetic joint infections post-surgery.

High blood glucose level is linked to an increased risk of periprosthetic joint infection in patients who receive total hip replacement surgery (also known as total hip arthroplasty), according to new research from Keck Medicine of USC. More than 20% of the revision surgeries required for total hip arthroplasty patients are associated with periprosthetic joint infection.

Past research has shown that hyperglycemia can increase a patient’s risk of developing a periprosthetic joint infection following total hip arthroplasty surgery. But few studies have assessed how preoperative blood sugar level, especially blood sugar level on the day surgery is performed, can indicate how likely a patient is to develop periprosthetic joint infection after the surgery.

A new study conducted by Jay R. Lieberman, MD, and Nathanael Heckmann, MD, from USC Orthopaedic Surgery, part of Keck Medicine of USC, aimed to identify the blood sugar level threshold that puts patients, both those with diabetes and without diabetes, at greater risk of developing periprosthetic joint infection.

Identifying the blood sugar threshold

Published in The Journal of Bone and Joint Surgery, this retrospective study reviewed the cases of more than 90,000 adult patients 18 years or older who had undergone primary, elective total hip arthroplasty between Jan. 1, 2016, and Dec. 31, 2021. These subjects’ blood sugar levels had been measured on the day of their surgery.

Patients with a preoperative diagnosis of diabetes, as well as patients without diabetes, were included. Applying regression analysis, the researchers examined the association between preoperative blood glucose level and development of periprosthetic joint infection within 90 days post-surgery.

In patients with diabetes who underwent total hip arthroplasty surgery, a preoperative blood sugar reading over 277 mg/dL was identified as the threshold at or above which the odds of developing periprosthetic joint infection were 1.5 times greater. In patients without diabetes, the threshold was a blood sugar level greater than 193 mg/dL. Approximately 2% of patients were noted to have these elevated glucose levels.

Assessing risk before surgery

Measuring a patient’s blood sugar level prior to surgery can inform surgeons about the potential infection risk that can develop post-surgery.

According to Lieberman, professor and chair of the Department of Orthopaedic Surgery at Keck School of Medicine of USC, “It is well established that patients with diabetes that have elevated blood glucose levels have an increased risk of developing an infection after total joint replacement. Our data suggests that all patients are at increased risk for infection if they have elevated blood glucose levels prior to their total joint replacement.”

USC Orthopaedic Surgery

USC Orthopaedic Surgery, part of Keck Medicine of USC, is one of the most comprehensive orthopaedic programs in the United States, offering expertise in diagnosis, treatment and rehabilitation of a wide array of orthopaedic issues. The clinicians provide care for a variety of subspecialties, including sports medicine, joint preservation and replacement, management of fractures and nonunions, hand surgery, foot and ankle disorders, musculoskeletal oncology, spinal disorders and treatment of infections. Embracing a multidisciplinary approach, orthopaedic surgeons collaborate with specialists in plastic surgery, microvascular and vascular surgery, and infectious disease to ensure the very best in patient care.