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Perioperative Management of Diabetes for Total Joint Arthoplasty

A Consensus Article

Livshetz, Isaac MD*; Nett, Michael MD

doi: 10.1097/BTO.0000000000000398

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.

*Department of Orthopaedic Surgery, Lenox Hill Hospital, Northwell Health, New York

Southside Hospital, Northwell Health Physician Partners, Orthopaedic Institute, Babylon, NY

This project was supported by an unrestricted grant from KCI, an Acelity company. Project management support was provided by MedicusWorks.

The authors declare that they have nothing to disclose.

For reprint requests, or additional information and guidance on the techniques described in the article, please contact Michael Nett, MD, at or by mail at Northwell Health Physician Partners, Orthopaedic Institute at Babylon, 400 West Main Street, Suite 301, Babylon, NY 11702. You may inquire whether the author(s) will agree to phone conferences and/or visits regarding these techniques.

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