Publication:

Association between haemoglobin A1C/albumin ratio and deep postoperative infection after total joint arthroplasty: a single centre study

Background Till the time in modern practice in a centre where total joint arthroplasty (TJA) including hip and knee mainly is being done in high volume (>100 TJA in a month), there are no guiding parameters to estimate the risk of developing periprosthetic infections in diabetes mellitus. This study aims to compare the risks of periprosthetic infection in patients undergoing total joint arthroplasty with diabetes mellitus (DM) and to investigate the predictive significance of the HbA1c/albumin ratio, so that a guideline can be given to avoid such dreaded complication in diabetic patients.

Methods Between January 2019 and January 2023, 490 patients who underwent total joint arthroplasty were analysed.187 diabetic patients were included in the study. 28 of them had periprosthetic infection. Six risk factors (Hba1c/albumin, age, BMI, ASA, length of hospital stay, and surgical duration) were analysed.

Results The rate of HbA1c/albumin was 13.9 times higher than the patients with ≤2.35 cut off value. (Hba1c/albumin ratio (odds ratio (OR)=13.9, 95% CI: 3.18-67.1, p: 0.01). BMI (OR=1.6, 95% CI: 1.168-2.199, p<0.003), DM (OR=0.365, 95% CI: 0.135-0.987, p: 0.04) and glucose (OR=1.016, 95% CI: 1.004-1.029, p: 0.011) were risk factures for periprosthetic infection. Albumin (OR=0.503, 95% CI: 0.109-2.314, p: 0.378) was not found to be a significant risk factor for periprosthetic infection.

Conclusions In view of our observation in present study we analysed that the HbA1c/albumin ratio has a reliable prognostic indicator than other risk factors in determining the chances of catching the risk of periprosthetic infection after TJA. HbA1c/albumin ratio is a cost effective and easily available parameter to many centres without posing much cost burden. Patients with an HbA1c/albumin cut-off ratio above 2.35 mg/dl in TJA better should avoided from surgery and should be followed more closely for the risk of periprosthetic infection after TJA.