Can Glucose Control Impact Total Joint Replacement Results?

Article Summary
  • Two Miller School orthopaedic surgeons are leading a study that looks at the impact of patient glucose levels on total joint replacement surgery outcomes.
  • This is the first large-scale study that analyzes glucose levels after joint replacement surgery.
  • This study hopes to reveal whether variations in glucose levels soon after surgery predict outcomes like readmission rates, surgical site infections and joint infections.

University of Miami Miller School of Medicine researchers have started to enroll total joint replacement patients for a groundbreaking study looking at the potential impact of glucose levels on surgical outcomes.

Victor H. Hernandez, M.D., associate professor of orthopaedic surgery in the Department of Orthopaedics and chief of the Division of Arthroplasty and Adult Joint Reconstruction, and Michele R. D’Apuzzo, M.D., associate professor of orthopaedic surgery and director of the Adult Reconstruction and Joint Replacement Fellowship Program, are co-principal investigators on the $300,000, three-year grant funded by the Orthopaedic Research and Education Foundation (OREF).

Illustration of knee after knee replacement surgery
Glucose levels can play a critical role in how patients do after total knee replacement surgery.

The research represents new territory for total joint reconstruction, including total hip and total knee replacement surgeries, according to Dr. D’Apuzzo.

“Large-scale scientific studies have not yet looked at what happens with glucose levels after joint replacement surgery. The only data available is based on single measurements and estimations,” Dr. D’Apuzzo said. “This is the first large study to look at the actual continuous level of glucose after surgery.”

Glucose and Joint Replacement

Previous research indicates that glucose may indicate how patients fare after common primary total hip and knee replacement procedures.

“We know, for example, that how stable a patient’s glycemic control is before and after surgery can play a critical role in how they do after the surgery, how well their wounds heal, how well their new joints feel, how quickly they rehab, how much energy they have…things like that,” said Gireesh B. Reddy, M.D., an orthopaedic surgery resident at the Miller School and an author on the study. 

Woman measuring her glucose levels by pricking her finger
The Miller School study will monitor glucose levels in the immediate aftermath of joint replacement surgery.

Steroids for pain management after hip surgery and knee surgery can cause spikes in glucose levels, as well.

“Higher glucose levels are associated with an increased risk of infection,” Dr. Hernandez said. “Infections are problematic for these patients and can delay wound healing and decrease their recovery.”

The Implications of Pre-Diabetes

Miller School researchers have shown in previous research that even patients who have pre-diabetes (insulin resistance) have more complications after surgery.

“The idea behind the current study is to measure patients’ glucose levels immediately after their procedures to see whether that minute-to-minute variation in glucose levels eventually affects their outcomes after surgery,” Dr. Reddy said. “To do this, we’re using a novel device called a continuous glucose monitor, the Dexcom G6, made by Dexcom, which is providing the devices for our study,”  

This study will reveal whether those variations in glucose levels predict readmission rates, surgical site infections, deeper prosthetic joint infections and more.

“Our aim is to use this knowledge to improve outcomes and decrease the risk of infections,” Dr. Hernandez said.

The researchers will enroll 2,400 diabetic, prediabetic and nondiabetic patients at the Miller School and then expand recruitment to other academic medical centers.

Tags: Department of Orthopaedics, Dr. Michele D'Apuzzo, Dr. Victor H. Hernandez, total hip replacement, total joint replacement, total knee replacement