Elevated Admission Blood Glucose Levels Are Associated With an Increased Risk of Periprosthetic Joint Infection in Re-Revision.

Background: The relationship between elevated blood glucose levels (BGLs) at admission for primary revision surgery and the risk of re-revision due to periprosthetic joint infection (PJI) remains unclear. This study aimed to: (1) investigate the association between elevated BGLs at admission for primary revision surgery and the risk of re-revision due to PJI; and (2) identify the optimal threshold for blood glucose control to minimize the risk of postoperative infection.

Methods: A total of 804 patients who underwent primary revision surgery between 2012 and 2024 were included. Of these, 648 patients had at least one year of follow-up (mean follow-up 7.4 years (range, 1.0 to 13.1). Blood glucose levels at admission were categorized into two groups: normal blood glucose (< 100 mg/dL) and elevated blood glucose (≥ 100 mg/dL). The primary outcome was the incidence of re-revision due to PJI, which was analyzed using multivariable logistic regression and propensity score matching to adjust for potential confounding factors.

Results: Admission BGL ≥ 100 mg/dL was independently associated with increased PJI risk (adjusted odds ratio = 3.35; 95% confidence interval: 1.21 to 9.20; P = 0.020). Nondiabetic patients exhibited greater susceptibility to hyperglycemia-related PJI, with a lower risk threshold (100 versus 109.6 mg/dL in diabetics). The optimal BGL threshold was 111.2 mg/dL, above which PJI risk increased nonlinearly by 1.5-fold.

Conclusions: Elevated admission BGL predicts re-revision due to PJI, particularly in nondiabetic patients. Perioperative glycemic control below 111.2 mg/dL may reduce infection risk.

Level Of Evidence: Level III, prognostic study.