Patients with Type 2 diabetes mellitus have a worse functional outcome post knee arthroplasty: A matched cohort study

Robertson, Francis P.; Geddes, Jacqueline; Ridley, David; McLeod, G.; Cheng, Kenneth

doi:10.1016/j.knee.2011.06.001

Cited by 58 publications

(25 citation statements)

References 22 publications

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“…Concerning comorbidities, Robertson et al [22] compared the outcomes of 367 TKAs in patients who had Type 2 diabetes mellitus with a matched nondiabetic control group. They reported that at 1-year (p \ 0.001) and 5-year (p \ 0.001) followup, patients who had diabetes had lower maximal flexion and total ROM compared with the nondiabetic control group.…”

Section: Discussionmentioning

confidence: 99%

Do Various Factors Affect the Frequency of Manipulation Under Anesthesia After Primary Total Knee Arthroplasty?

Issa

Rifai

Boylan

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background One of the most important goals of primary total knee arthroplasty (TKA) is to achieve a functional range of motion (ROM). However, up to 20% of patients fail to do so, which can impair activities of daily living. Questions/purposes The purpose of this study was to evaluate the effect of various (1) demographic factors;(2) comorbidities; and (3) knee-specific factors on the frequency of manipulation under anesthesia, which was used as an indicator of knee stiffness after a primary TKA. Methods We evaluated the registries of two high-volume centers and reviewed all 3182 TKAs that were performed between 2005 and 2011 to identify all patients who had undergone manipulation under anesthesia (MUA). A total of 156 knees in 133 patients underwent MUA after an index arthroplasty. These patients were compared in a one-to-four ratio with a group of patients with satisfactory ROM drawn from the same database who met prespecified criteria and who had not undergone MUA. Effects of various factors, including age, sex, body mass index, race, comorbidities, and the underlying cause of knee arthritis, were compared between these two cohorts using multivariable logistic regressions. Results After controlling for various confounding, nonwhite race was associated with an increase (odds ratio [OR], 2.01; p = 0.03), and age C 65 years (OR, 0.17; 95% confidence interval [CI], 0.04-0.74; p = 0.0179) was associated with a reduction in the incidence of MUA. In comorbidities, diabetes (OR, 1.72; 95% CI, 1.02-2.32; p = 0.03), high cholesterol levels (OR, 2.70; p = 0.03), and tobacco smoking (OR, 1.59; 95% CI, 1.03-2.47; p = 0.03) were associated with an increase in frequency of MUA. In knee-specific factors, preoperative knee ROM of less than 100°(OR, 0.80; p \ 0.0001) and knee osteonecrosis (p = 3.61; 95% CI, 1.29-10.1; p = 0.014) were associated with increased frequency of MUA. Conclusions We identified several demographic, medical, and knee-specific factors that were associated with poor

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Section: Discussionmentioning

confidence: 99%

Do Various Factors Affect the Frequency of Manipulation Under Anesthesia After Primary Total Knee Arthroplasty?

Issa

Rifai

Boylan

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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“…Diabetes mellitus (DM) is one of the most common and important diseases thought to be associated with an increased risk of perioperative complications among patients undergoing TKA. Previous studies have reported higher rates of infection [8,18,20,21,28], wound complications [5,6], greater risk of deep vein thrombosis [27,29], poorer outcomes [4,13,14,22,25], and higher mortality [2] in patients with DM undergoing TKA compared with patients without DM. Unfortunately, the prevalence of DM among patients undergoing TKA has been steadily increasing [11,15] and orthopaedic surgeons will be faced with a growing number of surgical patients with DM.…”

Section: Introductionmentioning

confidence: 99%

Do Glycemic Markers Predict Occurrence of Complications After Total Knee Arthroplasty in Patients With Diabetes?

Hwang

Kim

Bamne

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background Patients with diabetes have increased risk of infections and wound complications after total knee arthroplasty (TKA). Glycemic markers identifying patients at risk for complications after TKA have not yet been elucidated. Questions/purposes We aimed to determine the correlations among four commonly used glycemic markers and to identify the glycemic markers most strongly associated with the occurrence of surgical site infections and postoperative wound complications in patients with diabetes mellitus after undergoing TKA. Methods Our retrospective study included 462 patients with diabetes, who underwent a total of 714 TKAs. Blood levels of glycemic markers, including preoperative fasting blood glucose (FBG), postprandial glucose (PPG2), glycated hemoglobin (HbA 1c ), and levels obtained from random glucose testing on postoperative days 2, 5, and 14, were collected on all patients as part of a medical clearance program and an established clinical pathway for patients with diabetes at our center. Complete followup was available on 93% (462 of 495) of the patients. Correlations among markers were assessed. Associations between the markers and patient development of complications were analyzed using multivariate regression analyses of relevant cutoff values. We considered any of the following as complications potentially related to diabetes, and these were considered study endpoints: surgical site infection (superficial and deep) and wound complications (drainage, hemarthrosis, skin necrosis, and dehiscence). During the period of study, there were no fixed criteria applied to what levels of glycemic control patients with diabetes needed to achieve before undergoing arthroplasty, and there were wide ranges in the levels of all glycemic markers; for example, whereas the mean HbA 1c level was 7%, the range was 5% to 11.3%.Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research 1 editors and board members are on file with the publication and can be viewed on request. Each author certifies that his or her institution has approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent was obtained. This work was performed at the Joint Reconstruction Center, Seoul National University Bundang Hospital, Seoul, Republic of Korea. Results There were positive correlations among the levels of the four glycemic markers; the strongest correlation was found between the preoperative HbA 1c and PPG2 levels (R = 0.502, p \ 0.001). After controlling for potential confounding variables using multivariate analysis, the HbA 1c cutoff level of 8 (odds ratio [OR], 6.1; 95% confidence interval...

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“…Although complications following TKA are rare [8], the personal and fiscal costs can be overwhelming [9–12]. Attention has recently focused on identifying risk factors associated with adverse events [13–20], and worse clinical outcomes [21–24], following TKA, presuming the identification of modifiable variables may allow for preoperative intervention, potentially improving outcomes and decreasing cost.…”

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confidence: 99%

Hypothyroidism Increases 90-Day Complications and Costs Following Primary Total Knee Arthroplasty

Buller

Rosas

Sabeh

et al. 2018

The Journal of Arthroplasty

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Patients with Type 2 diabetes mellitus have a worse functional outcome post knee arthroplasty: A matched cohort study

Cited by 58 publications

References 22 publications

Do Various Factors Affect the Frequency of Manipulation Under Anesthesia After Primary Total Knee Arthroplasty?

Do Various Factors Affect the Frequency of Manipulation Under Anesthesia After Primary Total Knee Arthroplasty?

Do Glycemic Markers Predict Occurrence of Complications After Total Knee Arthroplasty in Patients With Diabetes?

Hypothyroidism Increases 90-Day Complications and Costs Following Primary Total Knee Arthroplasty

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