Delaying Joint Replacement Surgery Until Hemoglobin A_1c is Less Than 7%

Increasingly, orthopedists are insisting that diabetic patients lower their glycosylated hemoglobin (HbA_1c) levels to less than 7% before they undergo total joint arthroplasty. But this is far easier said than done, particularly in older patients, in whom tight control increases risk for potentially dangerous hypoglycemia. A study from the orthopedic clinic at a U.S. Veterans Affairs hospital illustrates this problem.

During a 5-year period, 59 diabetic patients who were deemed otherwise suitable for total hip or knee arthroplasty were not scheduled for surgery because their HbA_1c levels were >7%. The patients were referred back to their primary care physicians to intensify glycemic control. After an average of 8 months, 35 (59%) achieved Hb…