Prevalence and Risk of Infection in Patients with Diabetes following Primary Total Knee Arthroplasty: A Global Systematic Review and Meta-Analysis of 120,754 Knees

Abstract

Diabetes mellitus (DM) is a known risk factor for infection following total joint arthroplasty. This study looked at the prevalence and risk of infection in diabetic and non-diabetic patients who had primary total knee arthroplasty (TKA). PubMed, Scopus, Google Scholar, Web of Science, and Science Direct electronic databases were searched for studies published up to 21 April 2022. To compare the risk of infection between diabetic and non-diabetic subjects, a pooled prevalence, and a risk ratio (RR) with 95% confidence intervals (CIs) were used. This research has been registered with PROSPERO (CRD42021244391). There were 119,244 participants from 18 studies, with a total of 120,754 knees (25,798 diabetic and 94,956 non-diabetic). We discovered that the risks of infection in diabetic patients were 1.84 times significantly higher than in non-diabetic patients. Infection was more common in diabetic patients (1.9%) than in non-diabetic patients (1.2%). In a subgroup analysis, the risks of developing deep surgical site infection (SSI) were 1.96 times higher in diabetic patients, but no significant difference when compared in superficial SSI. Prevalence of deep SSI was higher in diabetic (1.5%) than in non-diabetic (0.7%), but the prevalence of superficial SSI was lower in diabetic (1.4%) than in non-diabetic (2.1%). Consistent with previous research, we found diabetes is a risk factor for infection following primary TKA. However, the risk is much lower than previously published data, indicating that other factors play a larger role in infection.

Evaluation of Comorbidities as Risk Factors for Fracture-Related Infection and Periprosthetic Joint Infection in Germany

“…Previous studies have demonstrated a strong correlation between diabetes mellitus and infections for PJIs and FRIs [ 12 , 30 ]. Breznicky et al (2020) described a relative risk for PJI between 2.2 and 3.5 depending on the therapy of diabetes [ 27 ], while Ahmand et al (2022) reported in their systematic review a 1.8 times increased risk for patients with diabetes mellitus compared to non-diabetic patients after total knee arthroplasty [ 36 ]. For FRI, as well, an increased risk with a higher rate of diabetes ( p = 0.050) in cases with postoperative infection was detected [ 26 ].…”

Using the Phecode System to Identify the Preoperative Clinical Phenotypes Associated with Surgical Site Infection in Patients Undergoing Primary Total Knee Arthroplasty: The Sex Differences

“…Among these included studies, six reported that diabetes increased the risk ratio of infection, while the other eight showed a null effect of diabetes. Although the authors [ 33 ] demonstrated a significant indication of diabetes as a risk factor, they concluded that the risk is much lower than implied by previously reported data, suggesting that other factors play a larger role in infection in this patient population.…”

“…Some of the comorbid conditions previously reported as risk factors for SSI, such as diabetes, metastatic cancer, rheumatoid arthritis, mental disorders, and renal diseases, were not supported in this study, and this result was also reported by several previous investigations [ 5 , 10 , 18 ], particularly in the Chinese population [ 5 , 18 ]. A recent meta-analysis [ 33 ] included 14 studies to calculate the risk of developing an infection in diabetic patients compared to non-diabetic patients following primary TKA. Among these included studies, six reported that diabetes increased the risk ratio of infection, while the other eight showed a null effect of diabetes.…”

Unveiling the silent nemesis: periprosthetic joint infection-the burden and road to recovery

“…12 Combining surgical interventions with targeted antibiotic therapy tailored to the specific pathogens identified is essential for successful management of PJI. 13 The specter of PJI looms as a formidable burden upon both patients and the healthcare system. Its consequences reverberate through the corridors of medical care, demanding our utmost attention and vigilance.…”