Perioperative Management of Diabetes for Total Joint Arthoplasty: A Consensus Article

Abstract

Diabetes mellitus (DM) is an increasingly prevalent comorbidity among patients undergoing total joint arthroplasty. Uncontrolled DM is a known risk factor for a multitude of postoperative complications, the most dreaded of which is periprosthetic joint infection, but also includes wound complications, deep venous thrombosis, and worse functional outcomes. Given that uncontrolled DM is a modifiable risk factor, it would be prudent for the surgeon to do all that is possible to minimize perioperative risks related to DM while also avoiding unnecessary surgical delays. In this article, we review risk mitigating measures including surgical screening, cutoff thresholds for hemoglobin A1C and maintaining good perioperative glycemic control. We recommend that all presurgical patients be screened for DM by measuring A1C. A value of 8.0% is a reasonable cutoff in surgical candidates and those falling above this value should be referred for glucose optimization before proceeding with surgery. Hemoglobin A1C has not been found to be a good predictor of postoperative complications and thus a strict A1C cutoff should be evaluated on a case by case basis. Maintaining tight glucose control, specifically avoiding hyperglycemia and large glucose fluctuations, is beneficial in the perioperative period and striving for a glucose goal between 80 and180 mg/dL is recommended.