The risk of periprosthetic joint infection after primary hip and knee replacements for osteoarthritis (OA) is increased by diabetes mellitus (DM). It also is increased by morbid obesity.
Jämsen and coworkers analyzed the 1-year incidence of periprosthetic joint infections in a series of 7181 primary hip and knee replacements performed to manage OA. Data about periprosthetic joint infection were collected from the hospital infection register and were based on prospective, active surveillance.
The periprosthetic joint infection rate increased from 0.37% in patients with a normal body mass index to 4.66% in the morbidly obese group. DM more than doubled the periprosthetic joint infection risk independent of obesity. The infection rate was highest in morbidly obese patients with DM. In patients who did not have a diagnosis of DM at the time of the surgery, there was a trend toward a higher infection rate in association with a preoperative glucose level of 6.9 mmol/L or higher compared with lower than 6.9 mmol/L. The infection rate was 1.15% in the former group compared with 0.28% in the latter.
The authors suggested that clinicians carefully weigh the benefits of joint replacement against the incidence of postoperative infection, especially in morbidly obese patients.