Clinical Orthopaedics and Related Research®

, Volume 467, Issue 6, pp 1577–1581 | Cite as

Obese Diabetic Patients are at Substantial Risk for Deep Infection after Primary TKA

Original Article

Abstract

We conducted a prospective study of 1214 consecutive primary TKAs to compare the deep prosthetic infection rate between obese and nonobese patients during the first 12 months after surgery. We also sought to determine whether patient or surgical variables such as comorbidities, age, gender, blood transfusion, use of surgical drains, and antibiotic-impregnated cement were predictors of subsequent prosthetic infection after primary TKA. The overall prosthetic infection rate was 1.5% (n = 18). The odds for a deep prosthetic infection were greater in patients with morbid obesity (odds ratio [OR], 8.96; 95% confidence interval, 1.59–50.63) and diabetes (OR, 6.87; 95% confidence interval, 2.42–19.56). Men were more likely to have a prosthetic infection develop than women (OR, 5.93; 95% confidence interval, 1.95–18.04) and the prosthetic infection rate was lower (OR, 0.24; 95% confidence interval, 0.06–0.95) in patients when a surgical drain was used. There were no prosthetic infections in patients with diabetes who were not obese. This compares with 11 prosthetic infections in patients who were obese and diabetic and four prosthetic infections in patients who were obese but not diabetic. Morbid obesity and obesity combined with diabetes are risk factors for periprosthetic infection after TKA.

Level of Evidence: Level II, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.

References

  1. 1.
    Amin AK, Patton JT, Cook RE, Brenkel IJ. Does obesity influence the clinical outcome at five years following total knee replacement for osteoarthritis? J Bone Joint Surg Br. 2006;88:335–340.PubMedCrossRefGoogle Scholar
  2. 2.
    Australian Orthopaedic Association. National Joint Replacement Registry Annual Report. Hip and knee replacement from September 1999 to December 2006. Adelaide:AOA. Available at: www.dmac.adelaide.edu.au/aoanjrr/publications.jsp. Accessed December 30, 2007.
  3. 3.
    Centers for Disease Control and Prevention. National Center for Health Statistics; BMI - Body Mass Index for Adults. Available at: http:/www.cdc.gov/nccdphp/dnpa/bmi/bmi-adult.htm. Accessed December 31, 2007.
  4. 4.
    Chesney D, Sales J, Elton R, Brenkel IJ. Infection after knee arthroplasty a prospective study of 1509 cases. J Arthroplasty. 2008;23:355–359.PubMedCrossRefGoogle Scholar
  5. 5.
    Dindo D, Muller MK, Weber M, Clavien PA. Obesity in general elective surgery. Lancet. 2003;361:2032–2035.PubMedCrossRefGoogle Scholar
  6. 6.
    Dowsey MM, Choong PF. Early outcomes and complications following joint arthroplasty in obese patients: a review of the published reports. ANZ J Surg. 2008;78:439–444.PubMedCrossRefGoogle Scholar
  7. 7.
    Dowsey MM, Choong PF. Obesity is a major risk factor for prosthetic infection after primary hip arthroplasty. Clin Orthop Relat Res. 2008;466:153–158.PubMedCrossRefGoogle Scholar
  8. 8.
    Dowsey MM, Kilgour ML, Santamaria NM, Choong PF. Clinical pathways in hip and knee arthroplasty: a prospective randomised controlled study. Med J Aust. 1999;170:59–62.PubMedGoogle Scholar
  9. 9.
    England SP, Stern SH, Insall JN, Windsor RE. Total knee arthroplasty in diabetes mellitus. Clin Orthop Relat Res. 1990;260:130–134.PubMedGoogle Scholar
  10. 10.
    Israelsson LA, Jonsson T. Overweight and healing of midline incisions: the importance of suture technique. Eur J Surg. 1997;163:175–180.PubMedGoogle Scholar
  11. 11.
    Jain NB, Guller U, Pietrobon R, Bond TK, Higgins LD. Comorbidities increase complication rates in patients having arthroplasty. Clin Orthop Relat Res. 2005;435:232–238.PubMedCrossRefGoogle Scholar
  12. 12.
    Joffe D, Yanagisawa RT. Metabolic syndrome and type 2 diabetes: can we stop the weight gain with diabetes? Med Clin North Am. 2007;91:1107–1123, ix.Google Scholar
  13. 13.
    Lai K, Bohm ER, Burnell C, Hedden DR. Presence of medical comorbidities in patients with infected primary hip or knee arthroplasties. J Arthroplasty. 2007;22:651–656.PubMedCrossRefGoogle Scholar
  14. 14.
    LeRoith D, Rayfield EJ. The benefits of tight glycemic control in type 2 diabetes mellitus. Clin Cornerstone. 2007;8 (suppl 7):S19–S29.PubMedCrossRefGoogle Scholar
  15. 15.
    Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guideline for prevention of surgical site infection, 1999. Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol. Apr 1999;20:250–278; quiz 279–280.CrossRefGoogle Scholar
  16. 16.
    Miric A, Lim M, Kahn B, Rozenthal T, Bombick D, Sculco TP. Perioperative morbidity following total knee arthroplasty among obese patients. J Knee Surg. 2002;15:77–83.PubMedGoogle Scholar
  17. 17.
    Namba RS, Paxton L, Fithian DC, Stone ML. Obesity and perioperative morbidity in total hip and total knee arthroplasty patients. J Arthroplasty. 2005;20(7 suppl 3):46–50.PubMedCrossRefGoogle Scholar
  18. 18.
    Parker MJ, Roberts CP, Hay D. Closed suction drainage for hip and knee arthroplasty: a meta-analysis. J Bone Joint Surg Am. 2004;86:1146–1152.PubMedCrossRefGoogle Scholar
  19. 19.
    Patel VP, Walsh M, Sehgal B, Preston C, DeWal H, Di Cesare PE. Factors associated with prolonged wound drainage after primary total hip and knee arthroplasty. J Bone Joint Surg Am. 2007;89:33–38.PubMedCrossRefGoogle Scholar
  20. 20.
    Peersman G, Laskin R, Davis J, Peterson M. Infection in total knee replacement: a retrospective review of 6489 total knee replacements. Clin Orthop Relat Res. 2001;392:15–23.PubMedCrossRefGoogle Scholar
  21. 21.
    Pomposelli JJ, Baxter JK 3rd, Babineau TJ, Pomfret EA, Driscoll DF, Forse RA, Bistrian BR. Early postoperative glucose control predicts nosocomial infection rate in diabetic patients. JPEN J Parenter Enteral Nutr. 1998;22:77–81.PubMedCrossRefGoogle Scholar
  22. 22.
    Ritter MA, Keating EM, Faris PM. Closed wound drainage in total hip or total knee replacement: a prospective, randomized study. J Bone Joint Surg Am. 1994;76:35–38.PubMedGoogle Scholar
  23. 23.
    Scheen AJ. Treatment of diabetes in patients with severe obesity. Biomed Pharmacother. 2000;54:74–79.PubMedCrossRefGoogle Scholar
  24. 24.
    Wilson JA, Clark JJ. Obesity: impediment to postsurgical wound healing. Adv Skin Wound Care. 2004;17:426–435.PubMedCrossRefGoogle Scholar
  25. 25.
    Winiarsky R, Barth P, Lotke P. Total knee arthroplasty in morbidly obese patients. J Bone Joint Surg Am. 1998;80:1770–1774.PubMedGoogle Scholar
  26. 26.
    Yang K, Yeo SJ, Lee BP, Lo NN. Total knee arthroplasty in diabetic patients: a study of 109 consecutive cases. J Arthroplasty. 2001;16:102–106.PubMedCrossRefGoogle Scholar

Copyright information

© The Association of Bone and Joint Surgeons 2008

Authors and Affiliations

  1. 1.Department of OrthopaedicsSt Vincent’s Hospital MelbourneMelbourneAustralia
  2. 2.Department of SurgeryMelbourne UniversityMelbourneAustralia

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