Graphic Illustration of TJA

Serum Glucose Variability and Risk of Complications After Revision TJA

In the current issue of JBJS, Goh et al. report on the association between glucose variability and postoperative complications following aseptic revision total joint arthroplasty (TJA). 

As the authors note, research has indicated that fluctuating glucose levels can increase the risk of perioperative morbidity and mortality. However, data have been lacking in the area of revision TJA, which can involve more complex procedures and greater risk of complications compared with primary TJA.  

Study Details 

  • The researchers identified 1,983 patients who underwent aseptic TJA (636 total knee and 1,347 total hip) from 2001 to 2019. Included were patients with ≥2 postoperative glucose values per day or ≥3 values during hospitalization. 
  • To assess glucose variability, the authors used the coefficient of variation (COV)—the ratio of the standard deviation to the mean. 
  • Multivariate regression was used to evaluate the association between glucose variability and outcome measures.  


The authors found that patients with high glycemic variability were at 1.7 times greater risk of 90-day complications and 2 times greater risk of periprosthetic joint infection (PJI) at minimum 1-year follow-up.  

In addition, the risk of 90-day complications went up by 2.2% and the risk of PJI increased by 1.8% for every percentage-point increase in COV. 

Greater length of stay was also found for patients with higher glucose variability.  

The authors conclude, “Higher glucose variability was associated with an increased risk of medical complications and PJI following aseptic revision TJA. Patients undergoing these complex procedures should have glucose levels monitored closely in the perioperative period. Future studies should evaluate the utility of continuous glucose monitoring in this high-risk population.” 


Learn more about this study. A video summary is available with the full report at 

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