Is There Maintenance of Preoperative Hemoglobin A1c Optimization Following Total Joint Arthroplasty in Patients Who Have Diabetes?

BACKGROUND: The prevalence of diabetes mellitus in total joint arthroplasty (TJA) patients has been reported as high as 20%. While preoperative hemoglobin A1c (HbA1c) optimization has been heavily studied and associated with improved outcomes in diabetic patients undergoing TJA, there is still limited research on the sustainability of maintaining optimized HbA1C levels during the peri- and postoperative period following TJA. METHODS: We queried our clinical database for all total hip arthroplasties (THAs) and total knee arthroplasties (TKAs) performed between January 1, 2016, and December 31, 2022. Analyses of HbA1c trends were conducted on patients who had at least two HbA1c values within the two years prior to their surgery, as well as at least two HbA1c test values within the two years following their surgery. A total of 976 THAs and 1,168 TKAs were performed during the 6-year period, including 245 THAs and 200 TKAs in patients who met the criteria for inclusion. The study examined several common thresholds for HbA1C optimization. RESULTS: Patients who had a more lenient preoperative optimization threshold had a greater rise in average HbA1c values within the two-year postoperative period. Within six months postoperatively, 19.6 and 34.4% of the THA and TKA patients, respectively, who underwent preoperative HbA1c optimization had postoperative HbA1c values greater than 7.5. This rose to 32.6% and 50.0% at one year and 50.0 and 62.5% at 2 years for THA and TKA patients, respectively. Furthermore, 21.2% of these patients did not have follow-up for their diabetes care within two years postoperatively. CONCLUSION: While preoperative optimization of HbA1c levels is achievable for many diabetic TJA patients, maintaining these improvements postoperatively requires a multifaceted approach. Enhanced patient education, coordinated care models, and the continued monitoring and emphasis on the importance of glycemic control are potential strategies for improving long-term diabetic management.