Postoperative Complications and Impact of Diabetes Mellitus Severity on Revision Total Knee Arthroplasty

Abstract

Total knee arthroplasty (TKA) is a common and effective treatment of knee osteoarthritis. As the amount of TKAs performed increases, so does the number of TKA failures and subsequent revisions. Diabetes mellitus (DM) has been shown to increase complications following orthopaedic procedures. For these reasons, it is important to understand the association between severity of DM and the risk of postoperative adverse events following revision TKA. A retrospective cohort study was conducted using the American College of Surgeons' National Surgical Quality Improvement Program database. Patients who underwent revision TKAs between 2007 and 2016 were identified and recorded as having noninsulin-dependent DM (NIDDM), insulin-dependent DM (IDDM), or no DM. Univariate and multivariate analysis were used to evaluate the incidence of multiple adverse events within 30 days after revision TKA. A total of 13,246 patients who underwent revision TKA were selected (without DM = 10,381 [78.4%]; NIDDM = 1,890 [14.3%]; IDDM = 975 [7.4%]). Patients with NIDDM were found to have an increased risk of developing renal insufficiency and urinary tract infection (UTI) compared with patients without DM, while patients with IDDM were found to have an increased risk of developing 10 of 20 adverse events compared with patients without DM. NIDDM is an independent risk factor for UTI and IDDM is an independent factor for development of three complications compared with no DM. Insulin dependency is an independent factor for septic shock, postoperative blood transfusion, and extended postoperative hospital stay. Relative to patients with NIDDM, those with IDDM have a greater likelihood of developing more adverse perioperative outcomes than patients without DM. Although complication rates remain relatively low, orthopaedic surgeons must consider the implications of diabetes and insulin dependence on patient selection, preoperative risk stratification, and postoperative outcomes.

Insulin Dependence Increases the Risk of Complications and Death in Total Joint Arthroplasty: A Systematic Review and Meta‐(Regression) Analysis

“…The mean age of patients among the groups ranged from 63 to 70.1 years. In this meta‐analysis, 3 articles included participants undergoing total shoulder arthroplasty (TSA) 10, 13, 21 , 6 included total knee arthroplasty (TKA) 15, 20, 24, 27–29 , 2 included revision total knee arthroplasty (rTKA) 14, 15 , 1 included total hip arthroplasty (THA) 30 , and the rest of the studies included both TKA and THA 16, 18, 19, 22, 23, 25, 26 . The mean NOS score was 6.18 (maximum 9), suggesting that this meta‐analysis included high‐quality studies.…”

“…Two articles 27, 29 were excluded because there were too few participants and there was high heterogeneity in the sensitivity analysis. Two studies reported the proportion of IDDM patients in among TSA patients 10, 13, 21 , whereas 2 articles reported the proportion of IDDM patients among revision knee arthroplasty patients 14, 15 , 4 reported the proportion of IDDM patients among THA patients 16, 17, 26, 30 , 6 studies reported the proportion of IDDM patients among TKA patients 16, 18, 20, 24, 26, 28 and 1 study separately reported the proportion of IDDM patients among THA and TKA patients 16 . In addition, 4 studies separately reported the proportion of IDDM patients among THA and TKA patients 19, 22, 23, 25 .…”

Tobacco Use Is Associated with More Severe Adverse Outcomes Than Morbid Obesity after Aseptic Revision TKA

“…32 Poor glycemic control in diabetic patients can contribute to adverse surgical outcomes, most notably with an increased risk for acute perioperative complications. 21,23,24 Lee et al reported increased medical complication rates, infection, and prolonged hospital length of stay in insulin-dependent diabetics. 23 While Maradit Kremers et al reported no difference in primary TKA failures among all diabetic patients, they noted an increased incidence of aseptic loosening among patients with elevated preadmis-sion blood glucose levels.…”

“…a Abbreviations: BMI, body mass index; CHF, congestive heart failure; DVT, deep vein thrombosis; PE, pulmonary embolism. a p < 0.01. b p < 0.05.these conditions exist individually 12,14,16,17,19,21,[23][24][25]30,31. In contrast to the study hypothesis, morbid obesity was not associated with an increased risk of reoperation or component revision.…”

Risk Factors for Blood Transfusion in Revision Total Hip Arthroplasty for Mechanical Failure

“…This is consistent with the findings of Gu et al, who reported that in revision TKA, IDDM was a risk factor for transfusion, while NIDDM was not found to have such an association. 56 The increased need for transfusions in diabetic patients may be explained by the fact that diabetes and metabolic syndrome have been reported to impair fibrinolysis and induce platelet dysfunction. 57 Further research is needed to elucidate the relationship between insulin dependence and transfusion requirements.…”