Risk optimization of periprosthetic joint infection in the diabetic patient
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Abstract
BACKGROUND: The lifespan of the US population is increasing with many people remaining active throughout their extended years. Often, when burdened with osteoarthritis, people will eventually look to a total joint arthroplasty (TJA) for relief of their symptoms and as a way to remain active. While it is a relatively routine operation, it has associated risks, especially in those who are diabetic. Diabetic patients are at an increased risk of developing periprosthetic joint infections (PJI), a costly complication with high morbidity and mortality.
LITERATURE REVIEW: Those with diabetes have a higher incidence of PJI after a TJA. The combination of a hyperglycemic state in the perioperative period and the ideal habitat for infection with the prosthesis harbors the increased risk. Often studies have been conducted retrospectively to gain a better understanding of the glycemic control required to reduce the risk but none have identified a definitive threshold. A clear threshold of glycemic control must be established through a prospective study that can strategically collect data to then minimize the risk of PJI in diabetic patients.
METHODS: This proposed study is a longitudinal cohort study that will track participants from their preoperative planning appointment for their TJA through two postoperative years. It will analyze two groups, one with known type 2 diabetes and one without diabetes. After analysis of the set time points at which both hemoglobin A1c and blood glucose are measured, a clear and safe threshold for glycemic control will be able to be defined for diabetic patients.
CONCLUSION: If a clear threshold can be identified from the proposed study that was deemed safe for those with diabetes to stay within in order to minimize risk of PJIs, then the results may be applied to a secondary study. This next study would test the identified threshold of glycemic control. This study aims to help decrease the economic and physical burden of PJIs.
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2024