Correlation between diabetes mellitus and periprosthetic joint infection following total joint arthroplasty: a systematic review_Chinese Journal of Evidence-Based Medicine

Authors：

FENG Wenxuan , XIAO Chunsheng , HE Zhipeng ,  YANG Yifan

The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510115, P. R. China;

Corresponding author：

YANG Yifan, Email: yyf0356@yeah.net

Keywords：

Diabetes mellitus; Total joint arthroplasty; Periprosthetic joint infection; Systematic review; Meta-analysis

DOI：

10.7507/1672-2531.202201130

Video：

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Objective To systematically review the correlation of diabetes mellitus (DM) with periprosthetic joint infection (PJI) after total joint arthroplasty (TJA). Methods Studies related to DM with PJI after TJA were collected from PubMed, EMbase and The Cochrane Library from inception to September 2021. Two reviewers independently screened the literature, extracted data and assessed the risk of bias of the included studies. Meta-analysis was then performed using Stata 13.0 software. Results A total of 26 studies involving 1 750 118 patients were included. The results of meta-analysis showed that the risk of PJI after TJA in DM patients was significantly higher than that in non-DM patients (OR=1.42, 95%CI 1.32 to 1.52, P<0.000 1). Conclusion Current evidence indicates a higher risk of PJI for DM patients than non-DM patients after TJA. Due to the limited quality and quantity of the included studies, more high-quality studies are required to verify the above conclusion.

Citation： FENG Wenxuan, XIAO Chunsheng, HE Zhipeng, YANG Yifan. Correlation between diabetes mellitus and periprosthetic joint infection following total joint arthroplasty: a systematic review. Chinese Journal of Evidence-Based Medicine, 2022, 22(7): 805-811. doi: 10.7507/1672-2531.202201130 Copy

1.	Schwartz AM, Farley KX, Guild GN, et al. Projections and epidemiology of revision hip and knee arthroplasty in the United States to 2030. J Arthroplasty, 2020, 35(6S): S79-S85.
2.	Li C, Renz N, Trampuz A. Management of Periprosthetic joint infection. Hip Pelvis, 2018, 30(3): 138-146.
3.	Aggarwal VK, Rasouli MR, Parvizi J. Periprosthetic joint infection: current concept. Indian J Orthop, 2013, 47(1): 10-17.
4.	Zmistowski B, Karam JA, Durinka JB, et al. Periprosthetic joint infection increases the risk of one-year mortality. J Bone Joint Surg Am, 2013, 95(24): 2177-2184.
5.	Gundtoft PH, Pedersen AB, Varnum C, et al. Increased mortality after prosthetic joint infection in primary THA. Clin Orthop Relat Res, 2017, 475(11): 2623-2631.
6.	Fu MC, Boddapati V, Dines DM, et al. The impact of insulin dependence on short-term postoperative complications in diabetic patients undergoing total shoulder arthroplasty. J Shoulder Elbow Surg, 2017, 26(12): 2091-2096.
7.	Webb ML, Golinvaux NS, Ibe IK, et al. Comparison of perioperative adverse event rates after total knee arthroplasty in patients with diabetes: insulin dependence makes a difference. J Arthroplasty, 2017, 32(10): 2947-2951.
8.	O'Toole P, Maltenfort MG, Chen AF, et al. Projected increase in periprosthetic joint infections secondary to rise in diabetes and obesity. J Arthroplasty, 2016, 31(1): 7-10.
9.	Iorio R, Williams KM, Marcantonio AJ, et al. Diabetes mellitus, hemoglobin A1C, and the incidence of total joint arthroplasty infection. J Arthroplasty, 2012, 27(5): 726-729.
10.	Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ, 2009, 339: b2535.
11.	Stroup DF, Berlin JA, Morton SC, et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. JAMA, 2000, 283(15): 2008-2012.
12.	Wells GA, Shea B, Connell DO, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of non-randomised studies in meta-analyses, 2011. Available at: http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp.
13.	Higgins JP, Thompson SG, Deeks JJ, et al. Measuring inconsistency in meta-analyses. BMJ, 2003, 327(7414): 557-560.
14.	Fox MW, Piepgras DG, Bartleson JD. Anterolateral decompression of the atlantoaxial vertebral artery for symptomatic positional occlusion of the vertebral artery. Case report. J Neurosurg, 1995, 83(4): 737-740.
15.	Cancienne JM, Brockmeier SF, Werner BC. Association of perioperative glycemic control with deep postoperative infection after shoulder arthroplasty in patients with diabetes. J Am Acad Orthop Surg, 2018, 26(11): e238-e245.
16.	Garbarino LJ, Gold PA, Anis HK, et al. Does intermittent catheterization compared to indwelling catheterization decrease the risk of periprosthetic joint infection following total knee arthroplasty. J Arthroplasty, 2020, 35(6S): S308-S312.
17.	Maradit Kremers H, Lewallen LW, Mabry TM, et al. Diabetes mellitus, hyperglycemia, hemoglobin A1C and the risk of prosthetic joint infections in total hip and knee arthroplasty. J Arthroplasty, 2015, 30(3): 439-443.
18.	Gupta A, Osmon DR, Hanssen AD, et al. Genitourinary procedures as risk factors for prosthetic hip or knee infection: a hospital-based prospective case-control study. Open Forum Infect Dis, 2015, 2(3): ofv097.
19.	Salt E, Wiggins AT, Rayens MK, et al. Moderating effects of immunosuppressive medications and risk factors for post-operative joint infection following total joint arthroplasty in patients with rheumatoid arthritis or osteoarthritis. Semin Arthritis Rheum, 2017, 46(4): 423-429.
20.	Dowsey MM, Choong PF. Obese diabetic patients are at substantial risk for deep infection after primary TKA. Clin Orthop Relat Res, 2009, 467(6): 1577-1581.
21.	Jämsen E, Nevalainen P, Eskelinen A, et al. Obesity, diabetes, and preoperative hyperglycemia as predictors of periprosthetic joint infection: a single-center analysis of 7181 primary hip and knee replacements for osteoarthritis. J Bone Joint Surg Am, 2012, 94(14): e101.
22.	Althoff A, Cancienne JM, Cooper MT, et al. Patient-related risk factors for periprosthetic ankle joint infection: an analysis of 6977 total ankle arthroplasties. J Foot Ankle Surg, 2018, 57(2): 269-272.
23.	Bozic KJ, Lau E, Kurtz S, et al. Patient-related risk factors for periprosthetic joint infection and postoperative mortality following total hip arthroplasty in Medicare patients. J Bone Joint Surg Am, 2012, 94(9): 794-800.
24.	Bozic KJ, Lau E, Kurtz S, et al. Patient-related risk factors for postoperative mortality and periprosthetic joint infection in medicare patients undergoing TKA. Clin Orthop Relat Res, 2012, 470(1): 130-137.
25.	Lai K, Bohm ER, Burnell C, et al. Presence of medical comorbidities in patients with infected primary hip or knee arthroplasties. J Arthroplasty, 2007, 22(5): 651-656.
26.	Namba RS, Inacio MC, Paxton EW. Risk factors associated with deep surgical site infections after primary total knee arthroplasty: an analysis of 56 216 knees. J Bone Joint Surg Am, 2013, 95(9): 775-782.
27.	Lenguerrand E, Whitehouse MR, Beswick AD, et al. Risk factors associated with revision for prosthetic joint infection after hip replacement: a prospective observational cohort study. Lancet Infect Dis, 2018, 18(9): 1004-1014.
28.	Lenguerrand E, Whitehouse MR, Beswick AD, et al. Risk factors associated with revision for prosthetic joint infection following knee replacement: an observational cohort study from England and Wales. Lancet Infect Dis, 2019, 19(6): 589-600.
29.	Morris BJ, O'Connor DP, Torres D, et al. Risk factors for periprosthetic infection after reverse shoulder arthroplasty. J Shoulder Elbow Surg, 2015, 24(2): 161-166.
30.	Triantafyllopoulos GK, Soranoglou VG, Memtsoudis SG, et al. Rate and risk factors for periprosthetic joint infection among 36 494 primary total hip arthroplasties. J Arthroplasty, 2018, 33(4): 1166-1170.
31.	Wu C, Qu X, Liu F, et al. Risk factors for periprosthetic joint infection after total hip arthroplasty and total knee arthroplasty in Chinese patients. PLoS One, 2014, 9(4): e95300.
32.	Blanco JF, Díaz A, Melchor FR, et al. Risk factors for periprosthetic joint infection after total knee arthroplasty. Arch Orthop Trauma Surg, 2020, 140(2): 239-245.
33.	McMaster Arthroplasty Collaborative (MAC). Risk factors for periprosthetic joint infection following primary total hip arthroplasty: a 15-year, population-based cohort study. J Bone Joint Surg Am, 2020, 102(6): 503-509.
34.	Bozic KJ, Ward DT, Lau EC, et al. Risk factors for periprosthetic joint infection following primary total hip arthroplasty: a case control study. J Arthroplasty, 2014, 29(1): 154-156.
35.	Pedersen AB, Mehnert F, Johnsen SP, et al. Risk of revision of a total hip replacement in patients with diabetes mellitus: a population-based follow up study. J Bone Joint Surg Br, 2010, 92(7): 929-934.
36.	Asensio A, Antolín FJ, Sanchez-García JM, et al. Timing of DVT prophylaxis and risk of postoperative knee prosthesis infection. Orthopedics, 2010, 33(11): 800.
37.	Duensing I, Anderson MB, Meeks HD, et al. Patients with type-1 diabetes are at greater risk of periprosthetic joint infection: a population-based, retrospective, cohort study. J Bone Joint Surg Am, 2019, 101(20): 1860-1867.
38.	Richards J, Inacio MC, Beckett M, et al. Patient and procedure-specific risk factors for deep infection after primary shoulder arthroplasty. Clin Orthop Relat Res, 2014, 472(9): 2809-2815.
39.	Sultan AA, Mahmood B, Samuel LT, et al. Patients with a history of treated septic arthritis are at high risk of periprosthetic joint infection after total joint arthroplasty. Clin Orthop Relat Res, 2019, 477(7): 1605-1612.
40.	Castano-Betancourt MC, Fruschein Annichino R, de Azevedo E Souza Munhoz M, et al. Identification of high-risk groups for complication after arthroplasty: predictive value of patient's related risk factors. J Orthop Surg Res, 2018, 13(1): 328.
41.	Tsang ST, Gaston P. Adverse peri-operative outcomes following elective total hip replacement in diabetes mellitus: a systematic review and meta-analysis of cohort studies. Bone Joint J, 2013, 95(11): 1474-1479.
42.	Resende VAC, Neto AC, Nunes C, et al. Higher age, female gender, osteoarthritis and blood transfusion protect against periprosthetic joint infection in total hip or knee arthroplasties: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc, 2021, 29(1): 8-43.
43.	Zhong J, Wang B, Chen Y, et al. Relationship between body mass index and the risk of periprosthetic joint infection after primary total hip arthroplasty and total knee arthroplasty. Ann Transl Med, 2020, 8(7): 464.
44.	Xiu F, Stanojcic M, Diao L, et al. Stress hyperglycemia, insulin treatment, and innate immune cells. Int J Endocrinol, 2014, 2014: 486403.
45.	Heller S, Rezapoor M, Parvizi J. Minimising the risk of infection: a peri-operative checklist. Bone Joint J, 2016, 98-B(1 Suppl A): 18-22.

1. Schwartz AM, Farley KX, Guild GN, et al. Projections and epidemiology of revision hip and knee arthroplasty in the United States to 2030. J Arthroplasty, 2020, 35(6S): S79-S85.
2. Li C, Renz N, Trampuz A. Management of Periprosthetic joint infection. Hip Pelvis, 2018, 30(3): 138-146.
3. Aggarwal VK, Rasouli MR, Parvizi J. Periprosthetic joint infection: current concept. Indian J Orthop, 2013, 47(1): 10-17.
4. Zmistowski B, Karam JA, Durinka JB, et al. Periprosthetic joint infection increases the risk of one-year mortality. J Bone Joint Surg Am, 2013, 95(24): 2177-2184.
5. Gundtoft PH, Pedersen AB, Varnum C, et al. Increased mortality after prosthetic joint infection in primary THA. Clin Orthop Relat Res, 2017, 475(11): 2623-2631.
6. Fu MC, Boddapati V, Dines DM, et al. The impact of insulin dependence on short-term postoperative complications in diabetic patients undergoing total shoulder arthroplasty. J Shoulder Elbow Surg, 2017, 26(12): 2091-2096.
7. Webb ML, Golinvaux NS, Ibe IK, et al. Comparison of perioperative adverse event rates after total knee arthroplasty in patients with diabetes: insulin dependence makes a difference. J Arthroplasty, 2017, 32(10): 2947-2951.
8. O'Toole P, Maltenfort MG, Chen AF, et al. Projected increase in periprosthetic joint infections secondary to rise in diabetes and obesity. J Arthroplasty, 2016, 31(1): 7-10.
9. Iorio R, Williams KM, Marcantonio AJ, et al. Diabetes mellitus, hemoglobin A1C, and the incidence of total joint arthroplasty infection. J Arthroplasty, 2012, 27(5): 726-729.
10. Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ, 2009, 339: b2535.
11. Stroup DF, Berlin JA, Morton SC, et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. JAMA, 2000, 283(15): 2008-2012.
12. Wells GA, Shea B, Connell DO, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of non-randomised studies in meta-analyses, 2011. Available at: http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp.
13. Higgins JP, Thompson SG, Deeks JJ, et al. Measuring inconsistency in meta-analyses. BMJ, 2003, 327(7414): 557-560.
14. Fox MW, Piepgras DG, Bartleson JD. Anterolateral decompression of the atlantoaxial vertebral artery for symptomatic positional occlusion of the vertebral artery. Case report. J Neurosurg, 1995, 83(4): 737-740.
15. Cancienne JM, Brockmeier SF, Werner BC. Association of perioperative glycemic control with deep postoperative infection after shoulder arthroplasty in patients with diabetes. J Am Acad Orthop Surg, 2018, 26(11): e238-e245.
16. Garbarino LJ, Gold PA, Anis HK, et al. Does intermittent catheterization compared to indwelling catheterization decrease the risk of periprosthetic joint infection following total knee arthroplasty. J Arthroplasty, 2020, 35(6S): S308-S312.
17. Maradit Kremers H, Lewallen LW, Mabry TM, et al. Diabetes mellitus, hyperglycemia, hemoglobin A1C and the risk of prosthetic joint infections in total hip and knee arthroplasty. J Arthroplasty, 2015, 30(3): 439-443.
18. Gupta A, Osmon DR, Hanssen AD, et al. Genitourinary procedures as risk factors for prosthetic hip or knee infection: a hospital-based prospective case-control study. Open Forum Infect Dis, 2015, 2(3): ofv097.
19. Salt E, Wiggins AT, Rayens MK, et al. Moderating effects of immunosuppressive medications and risk factors for post-operative joint infection following total joint arthroplasty in patients with rheumatoid arthritis or osteoarthritis. Semin Arthritis Rheum, 2017, 46(4): 423-429.
20. Dowsey MM, Choong PF. Obese diabetic patients are at substantial risk for deep infection after primary TKA. Clin Orthop Relat Res, 2009, 467(6): 1577-1581.
21. Jämsen E, Nevalainen P, Eskelinen A, et al. Obesity, diabetes, and preoperative hyperglycemia as predictors of periprosthetic joint infection: a single-center analysis of 7181 primary hip and knee replacements for osteoarthritis. J Bone Joint Surg Am, 2012, 94(14): e101.
22. Althoff A, Cancienne JM, Cooper MT, et al. Patient-related risk factors for periprosthetic ankle joint infection: an analysis of 6977 total ankle arthroplasties. J Foot Ankle Surg, 2018, 57(2): 269-272.
23. Bozic KJ, Lau E, Kurtz S, et al. Patient-related risk factors for periprosthetic joint infection and postoperative mortality following total hip arthroplasty in Medicare patients. J Bone Joint Surg Am, 2012, 94(9): 794-800.
24. Bozic KJ, Lau E, Kurtz S, et al. Patient-related risk factors for postoperative mortality and periprosthetic joint infection in medicare patients undergoing TKA. Clin Orthop Relat Res, 2012, 470(1): 130-137.
25. Lai K, Bohm ER, Burnell C, et al. Presence of medical comorbidities in patients with infected primary hip or knee arthroplasties. J Arthroplasty, 2007, 22(5): 651-656.
26. Namba RS, Inacio MC, Paxton EW. Risk factors associated with deep surgical site infections after primary total knee arthroplasty: an analysis of 56 216 knees. J Bone Joint Surg Am, 2013, 95(9): 775-782.
27. Lenguerrand E, Whitehouse MR, Beswick AD, et al. Risk factors associated with revision for prosthetic joint infection after hip replacement: a prospective observational cohort study. Lancet Infect Dis, 2018, 18(9): 1004-1014.
28. Lenguerrand E, Whitehouse MR, Beswick AD, et al. Risk factors associated with revision for prosthetic joint infection following knee replacement: an observational cohort study from England and Wales. Lancet Infect Dis, 2019, 19(6): 589-600.
29. Morris BJ, O'Connor DP, Torres D, et al. Risk factors for periprosthetic infection after reverse shoulder arthroplasty. J Shoulder Elbow Surg, 2015, 24(2): 161-166.
30. Triantafyllopoulos GK, Soranoglou VG, Memtsoudis SG, et al. Rate and risk factors for periprosthetic joint infection among 36 494 primary total hip arthroplasties. J Arthroplasty, 2018, 33(4): 1166-1170.
31. Wu C, Qu X, Liu F, et al. Risk factors for periprosthetic joint infection after total hip arthroplasty and total knee arthroplasty in Chinese patients. PLoS One, 2014, 9(4): e95300.
32. Blanco JF, Díaz A, Melchor FR, et al. Risk factors for periprosthetic joint infection after total knee arthroplasty. Arch Orthop Trauma Surg, 2020, 140(2): 239-245.
33. McMaster Arthroplasty Collaborative (MAC). Risk factors for periprosthetic joint infection following primary total hip arthroplasty: a 15-year, population-based cohort study. J Bone Joint Surg Am, 2020, 102(6): 503-509.
34. Bozic KJ, Ward DT, Lau EC, et al. Risk factors for periprosthetic joint infection following primary total hip arthroplasty: a case control study. J Arthroplasty, 2014, 29(1): 154-156.
35. Pedersen AB, Mehnert F, Johnsen SP, et al. Risk of revision of a total hip replacement in patients with diabetes mellitus: a population-based follow up study. J Bone Joint Surg Br, 2010, 92(7): 929-934.
36. Asensio A, Antolín FJ, Sanchez-García JM, et al. Timing of DVT prophylaxis and risk of postoperative knee prosthesis infection. Orthopedics, 2010, 33(11): 800.
37. Duensing I, Anderson MB, Meeks HD, et al. Patients with type-1 diabetes are at greater risk of periprosthetic joint infection: a population-based, retrospective, cohort study. J Bone Joint Surg Am, 2019, 101(20): 1860-1867.
38. Richards J, Inacio MC, Beckett M, et al. Patient and procedure-specific risk factors for deep infection after primary shoulder arthroplasty. Clin Orthop Relat Res, 2014, 472(9): 2809-2815.
39. Sultan AA, Mahmood B, Samuel LT, et al. Patients with a history of treated septic arthritis are at high risk of periprosthetic joint infection after total joint arthroplasty. Clin Orthop Relat Res, 2019, 477(7): 1605-1612.
40. Castano-Betancourt MC, Fruschein Annichino R, de Azevedo E Souza Munhoz M, et al. Identification of high-risk groups for complication after arthroplasty: predictive value of patient's related risk factors. J Orthop Surg Res, 2018, 13(1): 328.
41. Tsang ST, Gaston P. Adverse peri-operative outcomes following elective total hip replacement in diabetes mellitus: a systematic review and meta-analysis of cohort studies. Bone Joint J, 2013, 95(11): 1474-1479.
42. Resende VAC, Neto AC, Nunes C, et al. Higher age, female gender, osteoarthritis and blood transfusion protect against periprosthetic joint infection in total hip or knee arthroplasties: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc, 2021, 29(1): 8-43.
43. Zhong J, Wang B, Chen Y, et al. Relationship between body mass index and the risk of periprosthetic joint infection after primary total hip arthroplasty and total knee arthroplasty. Ann Transl Med, 2020, 8(7): 464.
44. Xiu F, Stanojcic M, Diao L, et al. Stress hyperglycemia, insulin treatment, and innate immune cells. Int J Endocrinol, 2014, 2014: 486403.
45. Heller S, Rezapoor M, Parvizi J. Minimising the risk of infection: a peri-operative checklist. Bone Joint J, 2016, 98-B(1 Suppl A): 18-22.

Chinese Journal of Evidence-Based Medicine

Correlation between diabetes mellitus and periprosthetic joint infection following total joint arthroplasty: a systematic review

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