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Diabetic management and infection risk in total ankle arthroplasty.

Publication ,  Journal Article
Wu, KA; Anastasio, AT; Krez, AN; O'Neill, C; Adams, SB; DeOrio, JK; Easley, ME; Nunley, JA
Published in: Foot Ankle Surg
April 16, 2024

BACKGROUND: As total ankle arthroplasty (TAA) increases in popularity nationwide for the management of end-stage arthritis, it is essential to understand ways to mitigate the risk of infection. Diabetes increases the risk of infection due to compromised immunity and impaired wound-healing mechanisms. However, there is limited research on how diabetic management, inclusive of medications and glucose control, may impact infection risks post-TAA. This study aims to demonstrate the impact of diabetic management on the occurrence of periprosthetic joint infection (PJI) following TAA. METHODS: This was a retrospective study of patients who underwent a TAA at a single academic institution from March 2002 to May 2022. Patients with diabetes who developed an intraarticular infection following TAA were propensity score matched (1:3) to diabetic patients who did not. Data collection included demographics, implant types, diabetic medications, and preoperative hemoglobin A1c. PJI was diagnosed based on Musculoskeletal Infection Society (MSIS) criteria. Statistical analyses assessed differences in medication use, glucose control, and infection rates between groups. RESULTS: Of the 1863 patients who underwent TAA, 177 patients had a diagnosis of diabetes. The infection rate in patients with diabetes (2.8%) was higher than the total cohort rate (0.8%). Five patients with diabetes developed a PJI at an average of 2.2 months postoperatively. This cohort (n = 5) was compared to propensity score-matched controls (n = 15). There was no significant difference in diabetic medication use. Patients who developed PJI had higher rates of uncontrolled diabetes (60.0% vs. 6.7%) and average A1c levels (7.02% vs. 6.29%) compared to controls. CONCLUSION: Our findings suggest that the elevated risk of PJI observed in individuals with diabetes subsequent to TAA may be attributed not solely to the presence of diabetes, but to inadequate glycemic control. Effectively managing blood glucose levels is imperative for achieving favorable outcomes following TAA. LEVEL OF EVIDENCE: III.

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Published In

Foot Ankle Surg

DOI

EISSN

1460-9584

Publication Date

April 16, 2024

Location

France

Related Subject Headings

  • Orthopedics
  • 3202 Clinical sciences
  • 1103 Clinical Sciences
 

Citation

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Wu, K. A., Anastasio, A. T., Krez, A. N., O’Neill, C., Adams, S. B., DeOrio, J. K., … Nunley, J. A. (2024). Diabetic management and infection risk in total ankle arthroplasty. Foot Ankle Surg. https://doi.org/10.1016/j.fas.2024.04.008
Wu, Kevin A., Albert T. Anastasio, Alexandra N. Krez, Conor O’Neill, Samuel B. Adams, James K. DeOrio, Mark E. Easley, and James A. Nunley. “Diabetic management and infection risk in total ankle arthroplasty.Foot Ankle Surg, April 16, 2024. https://doi.org/10.1016/j.fas.2024.04.008.
Wu KA, Anastasio AT, Krez AN, O’Neill C, Adams SB, DeOrio JK, et al. Diabetic management and infection risk in total ankle arthroplasty. Foot Ankle Surg. 2024 Apr 16;
Wu, Kevin A., et al. “Diabetic management and infection risk in total ankle arthroplasty.Foot Ankle Surg, Apr. 2024. Pubmed, doi:10.1016/j.fas.2024.04.008.
Wu KA, Anastasio AT, Krez AN, O’Neill C, Adams SB, DeOrio JK, Easley ME, Nunley JA. Diabetic management and infection risk in total ankle arthroplasty. Foot Ankle Surg. 2024 Apr 16;
Journal cover image

Published In

Foot Ankle Surg

DOI

EISSN

1460-9584

Publication Date

April 16, 2024

Location

France

Related Subject Headings

  • Orthopedics
  • 3202 Clinical sciences
  • 1103 Clinical Sciences