Factors Affecting Outcome after Total Knee Arthroplasty in Patients with Diabetes Mellitus

Abstract

PurposeTo compare the clinical outcome and complications following total knee arthroplasty (TKA) in diabetic and non-diabetic patients, and to identify diabetes-related risk factors for negative outcomes.Materials and Methods222 primary TKAs in patients with diabetes were evaluated using Knee Society scores and Hospital for Special Surgery score. Postoperative complications were reviewed retrospectively. The mean follow-up was 53.2 months. The effect of diabetesrelated factors and comparison with a matched control group were analyzed statistically.ResultsSignificant improvements were noted in all the scores after TKA (p < 0.05). There was no statistical difference in clinical sores between the diabetic and non-diabetic patients. In multivariate analysis associating age, gender and body mass index with pain and knee score at the latest follow-up, the average knee scores in normal and overweight group were found to be significantly higher than those in the obese group. The diabetic patients had an increased overall incidence of postoperative complications (17.6%) compared with the control group (8.1%) (p < 0.05). Particularly, the rate of wound complications such as skin necrosis, bulla formation or erythema with drainage was higher in the diabetic group (p < 0.05). Diabetes-related factors did not influence the incidence of complications. Associated diseases were the only significant risk factors correlated with wound complications and meniscal bearing dislodgement.ConclusionPatients with diabetes can benefit from TKA, even though diabetic patients are at an increased risk for overall postoperative and wound complications. Preoperative factors such as obesity and associated diseases may adversely affect the clinical outcome of TKA in diabetic patients.

Improving patients’ experience and outcome of total joint replacement: the RESTORE programme

“…In our literature search on the incidence of infection by diabetic status, we obtained data from 14 studies including 633,813 patients in which 3988 deep infections were recorded. 186,191,192,207,211,[213][214][215][216][217][218][219][220][221] In a random-effects meta-analysis shown in Figure 12, the relative risk for infection in patients with diabetes compared with non-diabetics was 2.03 (95% CI 1.54 to 2.67).…”

Bioburden after Staphylococcus aureus Inoculation in Type 1 Diabetic Rats Undergoing Internal Fixation

“…Indwelling devices are associated with a variety of complications, most importantly infection causing soft tissue damage and osteomyelitis 4,8,9 . These infections are generally difficult to manage and necessitate prolonged antibiotic therapy and revision surgery 5–7 .…”

“…Diabetic patients undergoing orthopedic surgery have increased rates of peri-operative complications 9,10 . Several large-scale case series studied predictability of post-operative infection 11–15 , with infection rates in diabetic patients of 7–10% compared to 1% in non-diabetics.…”

Review Article: Outcome of Total Knee Arthroplasty in Obese Patients

“…21,28 Obesity adversely affected clinical results in diabetic patients. 22 Improvement in Knee Society Scores after TKA was reported to be significantly lower in morbidly obese (>40 BMI) patients than in controls. 32 At 5 years post-TKA, Knee Society Scores were significantly lower in morbidly obese patients than in non-obese patients, but not significantly different between obese and non-obese patients.…”