Tuesday, 31 Mar 2020

You are here

Need for Pre-operative Hyperglycemia Testing Prior to Total Joint Replacement

JAMA reports on a  large Medicare cohort study showing that amongst patients undergoing total joint replacement (TJR), preoperative HbA1c testing was performed in 26% to 43% of patients with diabetes and in only 5% of those without diabetes. Importantly research has shown that an elevated HbA1c level is associated with postoperative complications. 

 

It is estimated that ther aer more than one million TJRs are performed annually in the United States.  Given a well known connnection between osteoarthritis and diabetes and that suboptimal glucose control preoperatively is associated with poor TJR outcomes, researchers at Brigham and Women’s Hosptial set our to assess the frequency of hemoglobin A1c (HbA1c) testing in the 90 days prior to surgery among Medicare enrollees, who were 65 years or older.

A total of 465 566 patients met the inclusion criteria, with a mean age ranged from 73 to 75 years.

In the 90 days prior to TJR, HbA1c testing occurred in: 

  • 4.9% of non-diabetic patients
  • 25.8% of those with diabetes not receiving medication
  • 39.0% of those with diabetes receiving noninsulin medications
  • 43.4% of those with diabetes receiving insulin.

Similar trends with serum glucose testing was seen, with 37.2% tested if they did not have diabetes increasing up to 50.2% in those with diabetes receiving insulin.

These findings suggest that assessing HbA1c would be a potentially important preoperative safety measure in patients undergoing TJR.

Disclosures: 
The author has no conflicts of interest to disclose related to this subject

Add new comment

More Like This

Diabetes in OA: Pain Is Worse

Among patients with knee osteoarthritis (OA), pain was greater for those with coexisting diabetes mellitus (DM), and this association was independent of obesity and radiographic severity, European researchers found. 

JAK Inhibitors Stimulate Osteoblasts

Science Translational Medicine has a report on how the use of Janus kinase (JAK) inhibitors may boost osteoblasts to battle bone erosions in conditions like rheumatoid arthritis (RA).

JAK inhibitors have been shown in clinical trials to retard the development of bone erosions while controlling RA inflammation and other clinical features.

Hormone Therapy for Postmenopausal Women

The NEJM weighs in on the problem of post-menopausal osteoporosis (OP) and tackles the use of hormonal therapy. The decline in estrogen after menopause may increase risks for osteoporosis, cardiovascular disease, and cognitive decline. The use of hormone replacement therapy (HRT) to obviate these issues may be primarily driven by hot flashes in postmenopausal women.1 Who may benefit from hormone therapy among postmenopausal women?

Knee Replacements Last 25 Years

UK registry reports that greater than 80% of total knee replacements can last for 25 years.

The outcomes regarding the duration and durability of knee arthroplasties is sketchy, with many orthopedists projecting a 15 to 20 year survivial. Hence the need for an appraisal of the data.

Should We Screen Younger Postmenopausal Women for Osteoporosis?

Do postmenopausal women, under age 65 years, need a baseline BMD testing? A JAMA Insights review suggests that the absolute risk of fracture is low in this group and that USPSTF guidelines should be considered - that we should be screening women younger than 65 years who are at increased risk of osteoporosis and we should be using a formal risk assessment tool to identify candidates for bone density testing.