Nijith O Govindan
An accurate glycemic control is dependent on an ideal glycemic marker to identify the patient at risk for complications after orthopaedic surgery. Recent evidences suggest that it is not the chronically elevated glucose levels that account for a higher postoperative risk of complications, rather the levels in the immediate peri-operative period. The purpose of this literature review is to look into the latest advances in glycemic markers, given the significance of diabetes in operative orthopaedics. Various indices in current practise includes - the traditional ones being plasma blood glucose (Fasting, Post prandial, Random sample), and Glycosylated Hemoglobin (HbA1c), and the novel markers serum fructosamine, Glycated Albumin (GA) and 1,5-Anhydroglucitol (1,5-AG). Multi-centric studies and systematic reviews have shown inconsistent association between the conventional HbA1c cut off and Peri-Prosthetic Joint Infection (PJI). Serum fructosamine seems to be a more promising marker for pre-operative glycemic optimisation in orthopaedics since it reflects glycemic control over 2-3 weeks, and assays are rapid, inexpensive, and values are not affected by the limitations of HbA1c.
Published Date: 2020-06-25; Received Date: 2020-06-09