Continuous Glucose Monitoring in Total Knee Arthroplasty With Preoperative High Dose Dexamethasone

Study Overview
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Brief Summary
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Perioperative joint infection (PJI) is a rare but serious postoperative complication from total knee arthroplasty (TKA) and it is known to cause significant morbidities to the patients suffering from it. Literatures have found evidence that there is correlation between patients' perioperative blood glucose level and their risks of developing PJI postoperatively. By monitoring patients' perioperative blood glucose level, clinicians may be able to better identify patients who are at risks of developing PJI. Continuous blood glucose level monitoring, where patients carry a blood glucose monitoring device, has been a novel intervention in various medical specialties for recording and monitoring patients' blood glucose levels. However, currently there has only limited studies using this intervention for perioperative blood glucose monitoring in patients who are receiving total knee arthroplasty. Intravenous dexamethasone is a widely used treatment for patients undergoing total knee arthroplasty as it has been shown in previous studies that it can provide good analgesic effect and also reduce patients' nauesea symptoms preoperatively. However, hyperglycaemia is also a known side effects from dexamethasone. There still has not been ample amount of investigation on how significant this potential effect is and at what period of time perioperatively that this side effect occurs. This study is designed to investigate how intravenous dexamethasone can potentially affect the perioperative blood glucose levels in patients receiving total knee arthroplasty. And by using a continuous glucose monitoring machine we are also aiming to find out the variability of the perioperative blood glucose profiles of these patients in order to design a better glucose monitoring schedule.

Detailed Description
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Perioperative joint infection (PJI) is a rare but serious postoperative complication from total knee arthroplasty (TKA) and it is known to cause significant morbidities to the patients suffering from it. Literatures have found evidence that there is correlation between patients' perioperative blood glucose level and their risks of developing PJI postoperatively. By monitoring patients' perioperative blood glucose level, clinicians may be able to better identify patients who are at risks of developing PJI. Continuous blood glucose level monitoring, where patients carry a blood glucose monitoring device, has been a novel intervention in various medical specialties for recording and monitoring patients' blood glucose levels. However, currently there has only limited studies using this intervention for perioperative blood glucose monitoring in patients who are receiving total knee arthroplasty. Intravenous dexamethasone is a widely used treatment for patients undergoing total knee arthroplasty as it has been shown in previous studies that it can provide good analgesic effect and also reduce patients' nauesea symptoms preoperatively. However, hyperglycaemia is also a known side effects from dexamethasone. There still has not been ample amount of investigation on how significant this potential effect is and at what period of time perioperatively that this side effect occurs. This study is designed to investigate how intravenous dexamethasone can potentially affect the perioperative blood glucose levels in patients receiving total knee arthroplasty. And by using a continuous glucose monitoring machine we are also aiming to find out the variability of the perioperative blood glucose profiles of these patients in order to design a better glucose monitoring schedule.

Official Title
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Continuous Glucose Monitoring in Total Knee Arthroplasty With Preoperative High Dose Dexamethasone: A Randomized Controlled Study

Conditions
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Diabetes, Knee Osteoarthritis

Intervention / Treatment
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* Procedure: Intraarticular injection of dexamethasone


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Obtained informed consent Adult patients (>18 years old) Primary osteoarthritis of knees scheduled for unilateral TKA Exclusion Criteria: Unable to obtain consent Refusal to continuous glucose monitoring Contraindication to dexamethasone Patients scheduled for one-staged bilateral Total Knee Arthroplasty (TKA) History of peptic ulcer/GI bleeding Hepatitis B carrier Patients on long-term steroid Patients requiring general anesthesia for the operation

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Supportive Care
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Triple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Diabetic patients with steroid<br> | Procedure: Intraarticular injection of dexamethasone<br>* Intraarticular injection of dexamethasone<br>|
| Placebo Comparator: Diabetic patients without steroid<br>Injection of normal saline | Procedure: Intraarticular injection of dexamethasone<br>* Intraarticular injection of dexamethasone<br>|
| Active Comparator: Pre-diabetic patients with steroid<br> | Procedure: Intraarticular injection of dexamethasone<br>* Intraarticular injection of dexamethasone<br>|
| Placebo Comparator: Pre-diabetic patients without steroid<br>Injection of normal saline | Procedure: Intraarticular injection of dexamethasone<br>* Intraarticular injection of dexamethasone<br>|
| Active Comparator: Non-diabetic patients with steroid<br> | Procedure: Intraarticular injection of dexamethasone<br>* Intraarticular injection of dexamethasone<br>|
| Placebo Comparator: Non-diabetic patients without steroid<br>Injection of normal saline | Procedure: Intraarticular injection of dexamethasone<br>* Intraarticular injection of dexamethasone<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Hyperglycaemia time | Amount of time where patients are at hyperglycaemic state | Within 1 week of admission |