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14-03-2013 | Metabolism | Article

Diabetes impact refuted for total knee arthroplasty

Abstract

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medwireNews: A diagnosis of diabetes does not preclude a good outcome in patients undergoing elective total knee arthroplasty (TKA), US researchers say.

Analysis of medical records for 40,491 TKA patients recorded in the Kaiser Permanente Total Joint Replacement Registry for 2001 through 2009 suggests diabetes diagnosis has no significant impact on the likelihood of five adverse outcomes.

Overall, 1.1% of the patients underwent revision arthroplasty, 0.7% developed deep infection, 1.0% had myocardial infarction, 1.0% developed venous thromboembolism, and 27.1% were rehospitalized within a year.

Multivariate analysis adjusting for age, gender, body mass index, and comorbidity showed varying trends according to diabetes status for both possible increased and decreased risks for these adverse outcomes, report Annette Adams (Kaiser Permanente Southern California, Pasadena) and co-authors.

However, there was no significant difference in the rate of any of the outcomes between the 81.3% of patients without diabetes, the 12.5% of patients with controlled diabetes (preoperative hemoglobin [Hb]A1c <7%), and the 6.2% of patients with uncontrolled diabetes (preoperative HbA1c =7%).

Noting their results contrast with previous research indicating an increased risk for postoperative complications in patients with diabetes, the team suggests in the Journal of Bone and Joint Surgery that other factors may be more prognostic than glycemic control, such as the presence of diabetic complications.

"Patients with diabetes remain at high risk for a number of adverse health outcomes affecting many organ systems, and continuing to review all available information about the overall health and stability of these vulnerable patients, including perioperative glycemic control status, remains prudent," the team comments.

In an accompanying editorial, Paul Manner (University of Washington, Seattle, USA) suggests that preoperative hyperglycemia may be a general marker for worse overall health.

"If this is the case, the good results seen with the two diabetic patient groups may reflect the heightened awareness of overall disease burden, including diabetes, with the Kaiser Permanente system devoting more resources to managing these patients," he says.

By Lynda Williams, Senior medwireNews Reporter

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