Diabetes Optimization in Total Joint Arthroplasty: Perioperative Markers, Pharmacologic Strategies, and Wound Care Best Practices

INTRODUCTION: Diabetes mellitus (DM) accompanies approximately 30% of hip/knee arthroplasty cases and more than doubles the risk of periprosthetic joint infection (PJI), wound failure, thromboembolism, and readmission. Consensus on perioperative glycemic management remains limited. METHODS: The PubMed/MEDLINE database (January 2000 to March 2025) was queried for English language studies of adults with DM undergoing primary or revision hip or knee arthroplasty. Combinations of "arthroplasty," "diabetes," "HbA1c," "fructosamine," "glycated albumin," "GLP1," "SGLT2," and "negative-pressure wound therapy" identified 162 eligible articles. Each was evaluated using the GRADE framework. RESULTS: Complication odds increased when preoperative HbA1c exceeded 7.5% or fasting glucose exceeded 115 mg/dL. Short-term biomarkers, fructosamine ≥292 µmol/L or glycated albumin >15.5%, predicted PJI and wound failure more accurately than HbA1c. Protocols that continued metformin, titrated insulin, and introduced preoperative GLP-1 receptor agonists reduced PJI by 43% and 90-day readmissions by 32%. In poorly controlled or obese patients, negative-pressure wound therapy with silver dressings lowered superficial infection rates by 35-40%. DISCUSSION: Adopting dynamic biomarker panels, prioritizing GLP-1-based regimens, and applying targeted incision management can meaningfully curb diabetes-related complications after arthroplasty. Prospective trials should refine biomarker cutoffs, weigh SGLT-2 risks against transfusion benefits, and define cost-effective wound care pathways.