Elective hip arthroplasty rates and related complications in people with diabetes mellitus

Abstract

Background and Aims: Diabetes mellitus (DM), poor glycaemic control and raised body mass index (BMI) have been associated with postoperative complications in arthroplasty, although the relative importance of these factors is unclear. We describe the prevalence of DM in elective hip arthroplasty in a UK centre, and evaluate the impact of these factors. Methods: We analysed retrospective data for DM patients undergoing arthroplasty over a 6-year period and compared with non-diabetic matched controls (1 DM patient: 5 controls). DM was present in 5.7% of hip arthroplasty patients (82/1443). Results: Postoperative complications occurred in 12.2% of DM patients versus 12.9% of controls ( p = 1.000); surgical complications were present in 6.1% of those with DM and 2.4% of controls ( p = 0.087), while medical complications occurred in 8.5% of DM patients versus 10.7% of controls ( p = 0.692). Complications developed in 23.1% of DM patients with poor glycaemic control (HbA1c > 53 mmol/mol) versus 9.8% with good control ( p = 0.169). In DM patients and controls combined, complications occurred in 16.3% of obese patients versus 10.0% of non-obese patients ( p = 0.043). In the DM cohort, 13.7% of overweight patients had complications versus 0% with a normal or low BMI ( p = 0.587). Conclusions: DM rates were lower than expected, and glycaemic control was good. Overall complication rates were unrelated to the presence of DM or to glycaemic control, although surgical complications were observed more frequently in those with DM and poor glycaemic control was uncommon within our cohort. Complications were more frequent in those with a higher BMI. Whether some patients with DM but without an increased risk of complications are currently being excluded from surgery requires exploration.

Continuous insulin infusion versus sliding scale for perioperative glycemic control in diabetic patients undergoing elective hip arthroplasty

“…Hyperglycemia directly contributes to the cartilage destruction observed in OA via oxidative stress, proinflammatory pathways, and acceleration of bone remodeling. This further reinforces the connections between these disorders [3] . The prevalence of DM in patients who undergo total hip arthroplasty (THA) and TKA might reach up to 52% [4] .…”

“…McVey et al [3] reported that Postoperative complications were equally likely in patients with DM (12.2%) and controls (12.9%) (p = 1.000). The impact of glycemic control on postoperative complications therefore remains unclear [3] . Our results aligned with the Aljuaid research as well.…”

“…Furthermore, other elements that were shown to be contributing in earlier research-such as the lack of concurrent comorbidities, ~ 109 ~ physical health, and the other discharge criteria-should also not be disregarded. A patient may be less likely to request surgery when their health is poor, a general practitioner may be less likely to refer a high-risk patient to the clinic, and an orthopaedic surgeon or anaesthetist may advise against arthroplasty when the operative risk outweighs the potential gains in function, according to the rate of superficial SSI reported by McVey et al [3] . Marchant et al [26] concluded that HbA1c was not associated with postoperative morbidity (Including surgical site infection) or mortality [27] .…”

Prevalence of modifiable risk factors in primary elective arthroplasty and their association with infections

“…Of the non-diabetic patients, 8% had dysglycemia and 2% had undiagnosed diabetes. The prevalence of diagnosed diabetes varies substantially between countries and therefore also in studies on TJA, or between 6% and 12%, as does undiagnosed diabetes, or up to 41% (23,24).…”

Impact of diabetic kidney disease on post-operative complications after primary elective total hip arthroplasty: a nationwide database analysis

“…Therefore, DM is associated with an increased risk of undergoing orthopedic surgery, particularly THA. Furthermore, diabetes has been associated with postoperative complications in THA, including prosthetic joint infection, persistent pain, and increased hospital costs, particularly when diabetes is poorly controlled [ 8 ]. Previous investigations employing various methodologies have documented elevated complication rates and suboptimal outcomes, including increased implant loosening and dislocation, in patients with CKD undergoing total hip arthroplasty [ 9 ].…”