The study authors sought to determine whether or not blood sugar level (glycemic control) influenced outcome in TKR. Fifty-two percent of people with diabetes have arthritis. Previous studies have found that poor glycemic control may cause postoperative complications.
Researchers reviewed records of more than 40,000 Kaiser Permanente patients who underwent TKRbetween January 2001 and December 2009, of whom 7,567 (18.7 percent) had diabetes, 464 underwent revision surgery (1.1 percent), and 287 (.7 percent) developed a deep infection. Of the total number of patients, 12.5 percent had controlled diabetes and 6.2 percent had uncontrolled diabetes.
In this study, researchers found no significant increase in risk for TKR revision, deep infection or deep vein thrombosis in patients with diabetes – controlled or uncontrolled – compared to patients without diabetes.
Other Key Findings:
- Patients with diabetes were more likely than patients without diabetes to be obese (56.7 percent compared with 40.3 percent), and have a severe comorbidity (related disease/condition) burden (17.5 percent compared with 2.4 percent).
- The rates of deep infection, deep vein thrombosis and pulmonary embolism (when a blood clot reaches the lungs) were low, and comparable in the controlled and uncontrolled diabetic groups to the non-diabetic group.
- Uncontrolled diabetics did not appear to be associated with an increased risk of myocardial infarction (heart attack) or rehospitalization.
- Controlled diabetics had a slightly greater percentage of revisions (1.7 percent) compared to uncontrolled diabetics (1.2 percent).
"This current study suggests that patients with diabetes who have higher glucose levels may not be at greater risk of poor surgical outcomes,” said Annette L. Adams, PhD, MPH, of the Kaiser Permanente Southern California Department of Research & Evaluation. “There appear to be other factors at play, and patients and their providers need to consider multiple factors, including but not limited to diabetes status, as they make decisions about whether to have this surgery."
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March 6 Full JBJS Table of Contents
Estimating the Burden of Total Knee Replacement in the United States
Early Postoperative Analgesic Effects of Single Epidural Ropivacaine Injection before Surgery in Posterior Lumbar Interbody Spinal Arthrodesis: A Pilot Randomized Controlled Trial
Meaningful Improvement in Perioperative Pain Control after Lumbar Surgery
Botulinum Toxin A Does Not Improve Cast Treatment for Idiopathic Toe-Walking: A Randomized Controlled Trial
Toxins for Toe-Walking: Should They be Used?
Transfemoral Amputations: The Trauma Effect of Residual Limb Length and Orientation on Gait Analysis Outcome Measures
Risk Factors for Infection and Amputation following Open Combat-Related Calcaneus Fractures
The IED Blast-Foot: Outcomes from Foot and Ankle Blast Injuries
Coxa Profunda is not a Useful Radiographic Parameter for Diagnosing Pincer-type Femoracetabular Impingement
March 20 Full JBJS Table of Contents
Surgical Outcomes in Total Knee Replacement Patients by Diabetes Status and Glycemic Control, 2001-2009
A Spoonful of Sugar – Commentary on Surgical Outcomes in Total Knee Replacement Patients by Diabetes Status and Glycemic Control, 2001-2009
The Effect of Aspirin on Bone Healing in a Rabbit Ulna Osteotomy Model
Six Degree of Freed Cervical Spine Range of Motion during Dynamic Flexion-Extension in Single-Level Anterior Arthrodesis Patients and Asymptomatic Control of Subjects
Adjacent Segment Range of Motion Following Anterior Cervical Fusion
Complications Observed Following Labral or Rotator Cuff Repair Using Poly-L Lactic Acid Implants
Ten-year Outcome of Serum Metal Ion Levels after Primary Total Hip Arthroplasty. A Concise Follow-up of a Previous Report
Tapering our Focus to the Causes and Correction of Metallosis in Primary Total Hip Arthroplasty
Arthroscopic Treatment for Osteochondral Defects of the Talus; an 8-to-20 Year Follow-up Study
Distal Femoral Valgus Deformity Following Plate Fixation of Pediatric Femoral Shaft Fractures
The Relationship between Social Deprivation and Incidence of Adult Fractures
Poor Mid-term Survival of Low-Carbide Metal-on-metal Zweymüller-Plus Total Hip Arthroplasty. A Concise Follow-up, at a Minimum of Ten Years, of a Previous Report
Report Integrity and Functional Outcomes for Arthroscopic Margin Convergence of Rotator Cuff Tears
An Anatomic Study of the Epiphyseal Tubercle and its Significance in the Pathogenesis of Slipped Capital Femoral Epiphysis
Fixation, Survival and Discoloration of Jumbo Acetabular Components in Revision Hip Arthroplasty
Methods to Decrease Post-operative Infections Following Posterior Cervical Spine Surgery
A Meta-analysis Comparing the Results of Cervical Disc Arthroplasty and Anterior Cervical Discectomy and Fusion (ACDF) in the Treatment of Symptomatic Cervical Disc Disease
Complications in Total Shoulder Arthroplasty
What’s New in Hand Surgery?
Moral Reasoning Strategies of Orthopaedic Surgery Residents
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More information on knee replacement can be found at orthoinfo.org