Patients with Diabetes at no Greater Risk for Infection or Other Complications after Total Knee Replacement

ROSEMONT, Ill., Feb. 27, 2013 /PRNewswire-USNewswire/ -- Patients with diabetes were no more likely to suffer infection, deep vein thrombosis (a deep vein blood clot) or other complications following total knee replacement (TKR) than patients without diabetes, according to new research published online today, in advance of its publication in the March 2013 Journal of Bone and Joint Surgery (JBJS).

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 TKR between 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, Ph.D., 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."

About JBJS

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

A Nation in Motion
More than one in four Americans have bone or joint health problems, making them the greatest cause of lost work days in the U.S. When orthopaedic surgeons restore mobility and reduce pain, they help people get back to work and to independent, productive lives. Orthopaedic surgeons provide the best value in American medicine in both human and economic terms and access to high-quality orthopaedic care keeps this "Nation in Motion." To learn more, to read hundreds of patient stories or to submit your own story, visit ANationinMotion.org.

More information on knee replacement can be found at orthoinfo.org

SOURCE Journal of Bone and Joint Surgery