Relations between Long-term Glycemic Control and Postoperative Wound and Infectious Complications after Total Knee Arthroplasty in Type 2 Diabetics

BACKGROUND: The authors examined whether poor preoperative glucose control, as indicated by the hemoglobin A1c (HbA1c) level of more than 8%, is associated with postoperative wound and infectious complications in diabetic patients that have undergone total knee arthroplasty (TKA). METHODS: One hundred and sixty-seven TKAs performed in 115 patients with type 2 diabetes mellitus, from January 2001 through March 2007, were retrospectively reviewed. Logistic regression was used to identify the variables that had a significant effect on the risk of wound complications or early deep infection. The variables considered were age, gender, body mass index, comorbidities, operation time, antibiotic-impregnated cement use, amount of blood transfusion, close suction drain use, duration of diabetes, method of diabetes treatment, diabetes complications, and preoperative HbA1c level. RESULTS: The overall incidence of wound complications was 6.6% (n = 11) and there were seven cases (4.2%) of early postoperative deep infection. Logistic regression revealed that the independent risk factors of wound complications were preoperative HbA1C > or = 8% (odds ratio [OR], 6.07; 95% confidence interval [CI], 1.12 to 33.0) and operation time (OR, 1.01; 95% CI, 1.00 to 1.03). No variable examined was found to be significantly associated with the risk of early postoperative deep infection. CONCLUSIONS: Poorly controlled hyperglycemia before surgery may increase the incidence of wound complications among diabetic patients after TKA.

Preoperative Risk Factors for Deep Infection Following Total Knee Replacements

PURPOSE: The aim of this study was to investigate the overall rate of deep infection and the risk factors for infection after primary total knee arhroplasties. MATERIALS AND METHODS: We conducted a retrospective case-control study of 229 patients (376 knees) who underwent total knee replacement (TKR) between January 2006 and June 2007 and who were followed up for more than one year. The risk factors for deep infection were determined via univariate analyses. RESULTS: The overall rate for developing infection was 1.9% (7 of 376). The risk factors were an operating theatre other than the main room (odds ratio=33.2, 95% confidence interval=1.9, 583.6) and a preoperative hemoglobin level lower than 12 mg% (odds ratio=4.3, 95% confidence interval=1.9, 9.4). CONCLUSION: The deep infection rates after TKRs might vary depending on the preoperative level of hemoglobin and the operating-room environment. Successful strategies to overcome the host and environmental risk factors are needed with the goal of preventing infection of the prosthesis.

Comparison of Postoperative Epidural Analgesia in the Two Staged Bilateral Total Knee Replacements / 대한마취과학회지

BACKGROUND: Modern studies have confirmed that interindividual pain threshold variability greatly exceeds intraindividual pain threshold variability. The purpose of this investigation was to compare the efficacy and safety of postoperative pain control by patient controlled analgesia (PCA) of two staged bilateral total knee replacements in the same patient. METHODS: Forty patients had two total knee replacements in separate sessions of anesthesia (a bilateral two stage procedure). They received postoperative pain treatment with patient-controlled epidural analgesia during the first postoperative 48 hours after total knee replacement. The procedures were assigned to the first operation (early group) and the second operation (late group) in the same patient. Visual analog scale (VAS) scores whilst at rest or during movement were used to assess pain. Total bupivacaine volume delivered, number of PCA requests, supplemental analgesics, overall satisfaction score and adverse events were evaluated. RESULTS: No significant differences were found between the two (early and late) groups in terms of effects and adverse events of postoperative pain control. CONCLUSIONS: Two staged bilateral total knee replacement appears to be a means of comparing postoperative pain control, and which significantly reduces interindividual variability.