Diabetes Optimization in Total Joint Arthroplasty: Perioperative Markers, Pharmacologic Strategies, and Wound Care Best Practices - PubMed
5 days ago
- #arthroplasty
- #glycemic-management
- #diabetes
- Diabetes mellitus (DM) is present in about 30% of hip/knee arthroplasty cases and significantly increases risks like periprosthetic joint infection (PJI), wound failure, thromboembolism, and readmission.
- Complication risks rise when preoperative HbA1c exceeds 7.5% or fasting glucose is over 115 mg/dL. Short-term biomarkers (fructosamine ≥292 µmol/L, glycated albumin >15.5%) predict PJI and wound failure better than HbA1c.
- Protocols involving metformin continuation, insulin titration, and preoperative GLP-1 receptor agonists reduced PJI by 43% and 90-day readmissions by 32%.
- Negative-pressure wound therapy with silver dressings lowered superficial infection rates by 35-40% in poorly controlled or obese patients.
- Dynamic biomarker panels, GLP-1-based regimens, and targeted incision management can effectively reduce diabetes-related complications post-arthroplasty.