Diabetes is associated with persistent pain after hip and knee replacement

Rajamäki, Tuomas J.; Jämsen, Esa; Puolakka, Pia A.; Nevalainen, Pasi; Moilanen, Teemu

doi:10.3109/17453674.2015.1044389

Cited by 50 publications

(38 citation statements)

References 26 publications

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“…Similar to the findings of earlier studies [18][19][20], drug use was more frequent especially when patient BMI exceeded 35 kg/ m 2 . Obese patients report more pain after joint replacement [7,18], which is one possible explanation for this finding. Obesity has also been associated with analgesic use in the general population [30,31].…”

Section: Discussionmentioning

confidence: 89%

“…Patients with epilepsy use more opioids in the general population [34], possibly due to a higher prevalence of painful conditions, and we found a similar finding in joint replacement recipients. Interestingly, although diabetes is associated with persistent postoperative pain [7], the disease was not associated with analgesic consumption, especially when their higher BMIs were taken into account [7]. Earlier, controversial results have been reported.…”

Section: Discussionmentioning

confidence: 98%

“…Although hip and knee replacement are performed to reduce pain and regain function in patients with late-stage arthritis [1,2], 10-20% of patients continue to suffer from persistent pain after surgery [3,4]. The latest studies focusing on persistent pain indicate that its major risk factors include pain catastrophizing, intensity of preoperative pain, mental health problems, knee surgery, and certain comorbidities, such as diabetes [4][5][6][7].…”

Section: Introductionmentioning

confidence: 99%

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Predictors of the use of analgesic drugs 1 year after joint replacement: a single-center analysis of 13,000 hip and knee replacements

et al. 2020

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Background: Pain persists in a moderate number of patients following hip or knee replacement surgery. Persistent pain may subsequently lead to the prolonged consumption of analgesics after surgery and expose patients to the adverse drug events of opioids and NSAIDs, especially in older patients and patients with comorbidities. This study aimed to identify risk factors for the increased use of opioids and other analgesics 1 year after surgery and focused on comorbidities and surgery-related factors. Methods: All patients who underwent a primary hip or knee replacement for osteoarthritis from 2002 to 2013 were identified. Redeemed prescriptions for acetaminophen, non-steroidal anti-inflammatory drugs (NSAIDs), and opioids (mild and strong) were collected from a nationwide Drug Prescription Register. The user rates of analgesics and the adjusted risks ratios for analgesic use 1 year after joint replacement were calculated.Results: Of the 6238 hip replacement and 7501 knee replacement recipients, 3591 (26.1%) were still using analgesics 1 year after surgery. Significant predictors of overall analgesic use (acetaminophen, NSAID, or opioid) were (risk ratio (95% CI)) age 65-74.9 years (reference < 65), 1.1 (1.03-1.2); age > 75 years, 1.2 (1.1-1.3); female gender, 1.2 (1.1-1.3); BMI 30-34.9 kg/m 2 (reference < 25 kg/m 2 ), 1.1 (1.04-1.2); BMI > 35 kg/m 2 , 1.4 (1.3-1.6); and a higher number of comorbidities (according to the modified Charlson Comorbidity Index score), 1. 2 (1.1-1.4). Diabetes and other comorbidities were not significant independent predictors. Of the other clinical factors, the preoperative use of analgesics, 2.6 (2.5-2.8), and knee surgery, 1.2 (1.1-1.3), predicted the use of analgesics, whereas simultaneous bilateral knee replacement (compared to unilateral procedure) was a protective factor, 0.86 (0.77-0.96). Opioid use was associated with obesity, higher CCI score, epilepsy, knee vs hip surgery, unilateral vs bilateral knee operation, total vs unicompartmental knee replacement, and the preoperative use of analgesics/opioids. Conclusions: Obesity (especially BMI > 35 kg/m 2 ) and the preoperative use of analgesics were the strongest predictors of an increased postoperative use of analgesics. It is remarkable that also older age and higher number of comorbidities predicted analgesic use despite these patients being the most vulnerable to adverse drug events.

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Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

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Predictors of the use of analgesic drugs 1 year after joint replacement: a single-center analysis of 13,000 hip and knee replacements

et al. 2020

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“…This is consistent with our findings of persistent symptoms and greater chance of developing symptomatic OA among those with multiple comorbidities including DM. Another study found a greater likelihood of persistent pain after joint replacement among individuals with DM, but not with metabolic syndrome or obesity [14]. However, in the JoCo OA, the lifetime risk of HOA did not vary substantially by BMI or other demographic features [5].…”

Section: Discussionmentioning

confidence: 93%

Comorbid conditions and the transition among states of hip osteoarthritis and symptoms in a community-based study: a multi-state time-to-event model approach

et al. 2020

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Background:We examined the association of three common chronic conditions (obesity, diabetes mellitus [DM], and cardiovascular disease [CVD]) with transitions among states of hip osteoarthritis (HOA). Methods: This longitudinal analysis used data from the Johnston County Osteoarthritis Project (JoCo OA, n = 3857), a community-based study in North Carolina, USA, with 18.4 ± 1.5 years of follow-up. Transitions across the following states were modeled: development of radiographic HOA (rHOA; Kellgren-Lawrence grade [KLG] of< 2); development of hip symptoms (self-reported hip pain, aching, or stiffness on most days) or symptomatic HOA (sxHOA; rHOA and symptoms in the same hip), and resolution of symptoms. Obesity (body mass index ≥ 30 kg/m 2 ) and self-reported DM and CVD were the time-dependent comorbid conditions of interest. Markov multi-state models were used to estimate adjusted hazard ratios and 95% confidence intervals to describe the associations between the conditions and HOA states. Results: The sample included 33% African Americans, 39% men, with a mean (SD) age of 62.2 (9.8) years; the frequencies of the comorbidities increased substantially over time. When considered individually, obesity was associated with incident hip symptoms, while CVD and DM were associated with reduced symptom resolution. For those with > 1 comorbidity, the likelihood of incident sxHOA increased, while that of symptom resolution significantly decreased. When stratified by sex, the association between obesity and incident symptoms was only seen in women; among men with DM versus men without, there was a significant (~75%) reduction in symptom resolution in those with rHOA. When stratified by race, African Americans with DM, versus those without, were much more likely to develop sxHOA. Conclusions: Comorbid chronic conditions are common in individuals with OA, and these conditions have a significant impact on the persistence and progression of HOA. OA management decisions, both pharmacologic and non-pharmacologic, should include considerations of the inter-relationships between OA and common comorbidities such as DM and CVD.

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“…Gharaibeh et al reported a positive correlation between diabetes and acute kidney injury in patients after THA. In terms of direct orthopaedics complications the following are mentioned: periprosthetic fractures, dislocations, aseptic loosening, persistent pain, revision risk and increased re‐admission rates . Martinez‐Huedo et al report higher rates of mortality in patients with DM vs non‐DM after TKAs and THAs.…”

Section: Impact Of Diabetes On Total Knee Arthroplasty (Tka) and Totamentioning

confidence: 99%

Influence of diabetes on tissue healing in orthopaedic injuries

Stolarczyk

Sarzyńska

Gondek

et al. 2018

Clin Exp Pharma Physio

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Diabetes is a group of metabolic diseases characterized by hyperglycaemia resulting from the defective action or secretion of insulin. Chronic hyperglycaemia can lead to the damage, dysfunction and failure of various organs. In the context of complications of healing and orthopaedic rehabilitation, vascular (microangiopathy) and nerve (neuropathy) disorders deserve particular attention. About 12% of the patients admitted to orthopaedic departments have diabetes. Studies indicate that there is an indisputable link between diabetes and: an increased risk of fractures, the difficult healing of injuries of bones, ligaments and musculotendinous. It appears that one of the main reasons for this is non-enzymatic glycosylation (glycation) of collagen molecules, a phenomenon observed in the elderly and diabetic populations, as it leads to the formation of advanced glycation end products (AGEs). Collagen is one of the major connective tissue components, and is therefore part of ligaments, tendons and bones. AGEs affect the weakening of its structure and biomechanical properties, and thus also affects the weakening of the structure and properties of the above-mentioned tissues. The aim of the study is to undertake an overview of the current knowledge of the impact of diabetes on the risk of some injuries and subsequent healing and rehabilitation of patients following orthopaedic injuries.

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Diabetes is associated with persistent pain after hip and knee replacement

Cited by 50 publications

References 26 publications

Predictors of the use of analgesic drugs 1 year after joint replacement: a single-center analysis of 13,000 hip and knee replacements

Predictors of the use of analgesic drugs 1 year after joint replacement: a single-center analysis of 13,000 hip and knee replacements

Comorbid conditions and the transition among states of hip osteoarthritis and symptoms in a community-based study: a multi-state time-to-event model approach

Influence of diabetes on tissue healing in orthopaedic injuries

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