The Interplay of Diabetes, Glucose Variability, and Antidiabetic Therapy in Preventing Periprosthetic Joint Infection Following Hip and Knee Arthroplasty: A Review Publisher Pubmed



Askari A ; Bazmi S ; Dehghani M ; Sepehrinia M ; Poursalehian M
Source: JBJS Reviews Published:2026

Abstract

» Traditional reliance on preoperative glycated hemoglobin (HbA1c) for surgical eligibility and periprosthetic joint infection (PJI) risk stratification has significant limitations, including surgical delays and poor reflection of short-term metabolic instability.» Perioperative hyperglycemia and glucose variability are stronger and more consistent determinants of PJI risk than static glycemic indices such as HbA1c.» Novel markers, such as fructosamine, and technologies, including continuous glucose monitoring, provide improved assessment of short-term glycemic control and variability and demonstrate superior prognostic utility for PJI compared with HbA1c.» Antidiabetic therapies may differentially influence PJI risk: insulin dependence marks higher risk, whereas oral agents, particularly metformin and glucagon-like peptide-1 receptor agonists, are increasingly associated with reduced short-term PJI risk, especially among diabetic and morbidly obese patients undergoing hip and knee arthroplasty.» Mechanistic evidence implicates effects on inflammation, angiogenesis, immune function, and bacterial biofilm formation in mediating the relationship between glycemic control, antidiabetic therapies, and PJI risk. Copyright © 2026 by The Journal of Bone and Joint Surgery, Incorporated