Ryan C Palmer, Sagar S Telang, Jacob R Ball, Julian Wier, Jay R Lieberman, Nathanael D Heckmann
{"title":"对“血红蛋白A1c作为全关节置换术后假体周围关节感染预测因子的有限效用：连续变量分析”的修正[The Journal of Arthroplasty 40(2025) 1836-1844]。","authors":"Ryan C Palmer, Sagar S Telang, Jacob R Ball, Julian Wier, Jay R Lieberman, Nathanael D Heckmann","doi":"10.1016/j.arth.2025.06.024","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Patients who have poorly controlled diabetes mellitus are at increased risk of periprosthetic joint infection (PJI). Nevertheless, an optimal preoperative hemoglobin A1c (HbA1c) threshold has not been established. This study sought to identify preoperative HbA1c thresholds that were predictive of adverse outcomes for total hip arthroplasty (THA) and total knee arthroplasty (TKA) patients.</p><p><strong>Methods: </strong>A healthcare database was used to identify primary THAs or TKAs performed from 2016 to 2021 with a preoperative HbA1c value within 28 days of surgery. The primary outcome was PJI within 90 days postoperatively. Secondary outcomes included aggregate medical and surgical complications. Restricted cubic splines were generated using logistic regression to quantify the impact of HbA1c as a continuous variable on the risk of PJI. Between HbA1c values of 5 and 12%, relevant sensitivity and specificity measurements were calculated at intervals of 0.5%. A Youden's J statistic identified clinically relevant preoperative HbA1c thresholds. In total, 17,481 elective arthroplasty patients who had a preoperative HbA1c were identified. The mean preoperative HbA1c was 6.5%.</p><p><strong>Results: </strong>For TKA, a PJI threshold of 9.7% was identified (sensitivity: 19.4%, specificity: 99.1%), while for THA, a PJI threshold of 7.8% was identified (sensitivity: 22.7%, specificity: 89.9%). The threshold for aggregate medical complications was 6.8% for TKA (sensitivity: 53.7%, specificity: 59.1%) and 6.5% for THA (sensitivity: 41.0%, specificity: 69.6%). No association was observed between HbA1c and aggregate surgical complications for either THA or TKA.</p><p><strong>Conclusions: </strong>This study identified PJI and medical complication HbA1c thresholds above which patients were at a significantly increased risk of early postoperative complications. While our findings suggest that HbA1c has limited predictive utility for postoperative complications, it remains an accessible biomarker that can aid in preoperative risk stratification. Future studies should explore other promising or complementary biomarkers that may be more effective for preoperative risk stratification.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.8000,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Erratum to 'The Limited Utility of Hemoglobin A1c as a Predictor for Periprosthetic Joint Infection Following Total Joint Arthroplasty: A Continuous Variable Analysis' [The Journal of Arthroplasty 40 (2025) 1836-1844].\",\"authors\":\"Ryan C Palmer, Sagar S Telang, Jacob R Ball, Julian Wier, Jay R Lieberman, Nathanael D Heckmann\",\"doi\":\"10.1016/j.arth.2025.06.024\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Patients who have poorly controlled diabetes mellitus are at increased risk of periprosthetic joint infection (PJI). Nevertheless, an optimal preoperative hemoglobin A1c (HbA1c) threshold has not been established. This study sought to identify preoperative HbA1c thresholds that were predictive of adverse outcomes for total hip arthroplasty (THA) and total knee arthroplasty (TKA) patients.</p><p><strong>Methods: </strong>A healthcare database was used to identify primary THAs or TKAs performed from 2016 to 2021 with a preoperative HbA1c value within 28 days of surgery. The primary outcome was PJI within 90 days postoperatively. Secondary outcomes included aggregate medical and surgical complications. Restricted cubic splines were generated using logistic regression to quantify the impact of HbA1c as a continuous variable on the risk of PJI. Between HbA1c values of 5 and 12%, relevant sensitivity and specificity measurements were calculated at intervals of 0.5%. A Youden's J statistic identified clinically relevant preoperative HbA1c thresholds. In total, 17,481 elective arthroplasty patients who had a preoperative HbA1c were identified. The mean preoperative HbA1c was 6.5%.</p><p><strong>Results: </strong>For TKA, a PJI threshold of 9.7% was identified (sensitivity: 19.4%, specificity: 99.1%), while for THA, a PJI threshold of 7.8% was identified (sensitivity: 22.7%, specificity: 89.9%). The threshold for aggregate medical complications was 6.8% for TKA (sensitivity: 53.7%, specificity: 59.1%) and 6.5% for THA (sensitivity: 41.0%, specificity: 69.6%). No association was observed between HbA1c and aggregate surgical complications for either THA or TKA.</p><p><strong>Conclusions: </strong>This study identified PJI and medical complication HbA1c thresholds above which patients were at a significantly increased risk of early postoperative complications. While our findings suggest that HbA1c has limited predictive utility for postoperative complications, it remains an accessible biomarker that can aid in preoperative risk stratification. Future studies should explore other promising or complementary biomarkers that may be more effective for preoperative risk stratification.</p><p><strong>Level of evidence: </strong>Level III.</p>\",\"PeriodicalId\":51077,\"journal\":{\"name\":\"Journal of Arthroplasty\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":3.8000,\"publicationDate\":\"2025-07-28\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Arthroplasty\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.arth.2025.06.024\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"ORTHOPEDICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Arthroplasty","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.arth.2025.06.024","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
Erratum to 'The Limited Utility of Hemoglobin A1c as a Predictor for Periprosthetic Joint Infection Following Total Joint Arthroplasty: A Continuous Variable Analysis' [The Journal of Arthroplasty 40 (2025) 1836-1844].
Background: Patients who have poorly controlled diabetes mellitus are at increased risk of periprosthetic joint infection (PJI). Nevertheless, an optimal preoperative hemoglobin A1c (HbA1c) threshold has not been established. This study sought to identify preoperative HbA1c thresholds that were predictive of adverse outcomes for total hip arthroplasty (THA) and total knee arthroplasty (TKA) patients.
Methods: A healthcare database was used to identify primary THAs or TKAs performed from 2016 to 2021 with a preoperative HbA1c value within 28 days of surgery. The primary outcome was PJI within 90 days postoperatively. Secondary outcomes included aggregate medical and surgical complications. Restricted cubic splines were generated using logistic regression to quantify the impact of HbA1c as a continuous variable on the risk of PJI. Between HbA1c values of 5 and 12%, relevant sensitivity and specificity measurements were calculated at intervals of 0.5%. A Youden's J statistic identified clinically relevant preoperative HbA1c thresholds. In total, 17,481 elective arthroplasty patients who had a preoperative HbA1c were identified. The mean preoperative HbA1c was 6.5%.
Results: For TKA, a PJI threshold of 9.7% was identified (sensitivity: 19.4%, specificity: 99.1%), while for THA, a PJI threshold of 7.8% was identified (sensitivity: 22.7%, specificity: 89.9%). The threshold for aggregate medical complications was 6.8% for TKA (sensitivity: 53.7%, specificity: 59.1%) and 6.5% for THA (sensitivity: 41.0%, specificity: 69.6%). No association was observed between HbA1c and aggregate surgical complications for either THA or TKA.
Conclusions: This study identified PJI and medical complication HbA1c thresholds above which patients were at a significantly increased risk of early postoperative complications. While our findings suggest that HbA1c has limited predictive utility for postoperative complications, it remains an accessible biomarker that can aid in preoperative risk stratification. Future studies should explore other promising or complementary biomarkers that may be more effective for preoperative risk stratification.
期刊介绍：
The Journal of Arthroplasty brings together the clinical and scientific foundations for joint replacement. This peer-reviewed journal publishes original research and manuscripts of the highest quality from all areas relating to joint replacement or the treatment of its complications, including those dealing with clinical series and experience, prosthetic design, biomechanics, biomaterials, metallurgy, biologic response to arthroplasty materials in vivo and in vitro.
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