Skip to main content

Advertisement

SpringerLink
Log in

Inadequate pre-operative glycaemic control in patients with diabetes mellitus adversely influences functional recovery after total knee arthroplasty

Patients with impaired glycaemic control exhibit poorer functional outcomes at 1-year post-arthroplasty

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Whilst inadequate glycaemic control is associated with an increase in perioperative complications following total knee arthroplasty, the impact of glycaemic control in this at-risk patient group remains ill-defined. Identification of at-risk patients would allow targeted pre-operative glycaemic control intervention.

Methods

One hundred consecutive patients with a diagnosis of diabetes mellitus and one hundred age, sex and BMI matched patients without diabetes undergoing total knee arthroplasty in a single institution were analysed between 2008 and 2013. Inadequate glycaemic control was defined as having an HbA1c of greater than 64 mmol/mol (8.0 % NGSP) measured within the 3 months before surgery. Patient demographics, diabetes management and complications of diabetes were recorded and used as explanatory variables to deliver a generalised linear model. This allows for relationships to be defined between change in patient-reported function (SF-36, WOMAC) and these explanatory variables.

Results

The patient group with concomitant diabetes exhibited smaller improvements in WOMAC and SF-36 physical component summary at 1 year after knee arthroplasty. This effect was most pronounced in the subset of patients with inadequate glycaemic control recorded in the early pre-operative period.

Conclusion

Patients with diabetes, particularly those with inadequate glycaemic control, exhibit less improvement at 1 year following knee arthroplasty than patients without diabetes mellitus. Clinical focus on modulating this factor in this at-risk group is warranted.

Level of evidence

III.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW (1988) Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol 15:1833–1840

    CAS  PubMed  Google Scholar 

  2. Bolognesi MP, Marchant MH Jr, Viens NA, Cook C, Pietrobon R, Vail TP (2008) The impact of diabetes on perioperative patient outcomes after total hip and total knee arthroplasty in the United States. J Arthroplasty 23:92–98

    Article  PubMed  Google Scholar 

  3. Chen L, Nelson DR, Zhao Y, Cui Z, Johnston JA (2013) Relationship between muscle mass and muscle strength, and the impact of comorbidities: a population-based, cross-sectional study of older adults in the United States. BMC Geriatr 13:74

    Article  PubMed  PubMed Central  Google Scholar 

  4. Clement ND, MacDonald D, Burnett R, Breusch SJ (2013) Diabetes does not influence the early outcome of total knee replacement: a prospective study assessing the Oxford knee score, short form 12, and patient satisfaction. Knee 20:437–441

    Article  CAS  PubMed  Google Scholar 

  5. Daultrey H, Gooday C, Dhatariya K (2011) Increased length of inpatient stay and poor clinical coding: audit of patients with diabetes. JRSM Short Rep 2:83

    Article  PubMed  PubMed Central  Google Scholar 

  6. Harris AH, Bowe TR, Gupta S, Ellerbe LS, Giori NJ (2013) Hemoglobin A1C as a marker for surgical risk in diabetic patients undergoing total joint arthroplasty. J Arthroplasty 28:25–29

    Article  PubMed  Google Scholar 

  7. Holman N, Forouhi NG, Goyder E, Wild SH (2011) The Association of Public Health Observatories (APHO) diabetes prevalence model: estimates of total diabetes prevalence for England, 2010–2030. Diabet Med 28:575–582

    Article  CAS  PubMed  Google Scholar 

  8. Marchant MH Jr, Viens NA, Cook C, Vail TP, Bolognesi MP (2009) The impact of glycemic control and diabetes mellitus on perioperative outcomes after total joint arthroplasty. J Bone Joint Surg Am 91:1621–1629

    Article  PubMed  Google Scholar 

  9. Meding JB, Reddleman K, Keating ME, Klay A, Ritter MA, Faris PM, Berend ME (2003) Total knee replacement in patients with diabetes mellitus. Clin Orthop Relat Res 316:208–216

    Article  Google Scholar 

  10. Moon HK, Han CD, Yang IH, Cha BS (2008) Factors affecting outcome after total knee arthroplasty in patients with diabetes mellitus. Yonsei Med J 49:129–137

    Article  PubMed  PubMed Central  Google Scholar 

  11. Park SW, Goodpaster BH, Strotmeyer ES, de Rekeneire N, Harris TB, Schwartz AV, Tylavsky FA, Newman AB (2006) Decreased muscle strength and quality in older adults with type 2 diabetes: the health, aging, and body composition study. Diabetes 55:1813–1818

    Article  CAS  PubMed  Google Scholar 

  12. Pruzansky JS, Bronson MJ, Grelsamer RP, Strauss E, Moucha CS (2014) Prevalence of modifiable surgical site infection risk factors in hip and knee joint arthroplasty patients at an urban academic hospital. J Arthroplasty 29:272–276

    Article  PubMed  Google Scholar 

  13. Reategui D, Sanchez-Etayo G, Nunez E, Tio M, Popescu D, Nunez M, Lozano L (2015) Perioperative hyperglycaemia and incidence of post-operative complications in patients undergoing total knee arthroplasty. Knee Surg Sport Traumatol Arthrosc 23(7):2026–2031

    Article  Google Scholar 

  14. Singh JA, Lewallen DG (2013) Diabetes: a risk factor for poor functional outcome after total knee arthroplasty. PLoS ONE 13(8):e78991

    Article  Google Scholar 

  15. Stryker LS (2016) Modifying risk factors: strategies that work diabetes mellitus. J Arthroplasty. doi:10.1016/j.arth.2016.02.084

    Google Scholar 

  16. Tamayo T, Rosenbauer J, Wild SH, Spijkerman AM, Baan C, Forouhi NG, Herder C, Rathmann W (2014) Diabetes in Europe: an update. Diabet Res Clin Pract 103(2):206–217

    Article  CAS  Google Scholar 

  17. Underwood P, Askari R, Hurwitz S, Chamarthi B, Garg R (2014) Preoperative A1C and clinical outcomes in patients with diabetes undergoing major noncardiac surgical procedures. Diabet Care 37:611–616

    Article  CAS  Google Scholar 

  18. Volpato S, Bianchi L, Lauretani F, Lauretani F, Bandinelli S, Guralnik JM, Zuliani G, Ferrucci L (2012) Role of muscle mass and muscle quality in the association between diabetes and gait speed. Diabet Care 35:1672–1679

    Article  Google Scholar 

  19. Wang S, Zhao Y (2013) Diabetes mellitus and the incidence of deep vein thrombosis after total knee arthroplasty: a retrospective study. J Arthroplasty 28:595–597

    Article  PubMed  Google Scholar 

  20. Ware JE Jr, Sherbourne CD (1992) The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care 30:473–483

    Article  PubMed  Google Scholar 

  21. Wild S, Roglic G, Green A, Sicree R, King H (2004) Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabet Care 27:1047–1053

    Article  Google Scholar 

  22. Yang Z, Liu H, Xie X, Tan Z, Qin T, Kang P (2014) The influence of diabetes mellitus on the post-operative outcome of elective primary total knee replacement: a systematic review and meta-analysis. Bone Joint J 96-b:1637–1643

    Article  CAS  PubMed  Google Scholar 

Download references

Author contributions

This manuscript outlines independent investigator-initiated research. The views expressed are solely that of the authors. DJD conceived the study, designed the study and reviewed the manuscript. TB designed the study, participated in data analysis and wrote the manuscript. MW designed the study and reviewed the manuscript. MB was involved in data collection and reviewed the manuscript. MS was responsible for statistical analysis and review of the manuscript. All authors were involved in drafting the manuscript and revising it for important intellectual content and give permission for this version to be published. All authors read and approved the final manuscript.

Author information

Authors and Affiliations

  1. Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK

    Timothy M. Brock, Mark Shirley, Michelle Bardgett, Mark Walker & David J. Deehan

Authors
  1. Timothy M. Brock
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mark Shirley
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Michelle Bardgett
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mark Walker
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. David J. Deehan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Timothy M. Brock.

Ethics declarations

Conflict of interest

The authors declare no competing interests.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 15 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Brock, T.M., Shirley, M., Bardgett, M. et al. Inadequate pre-operative glycaemic control in patients with diabetes mellitus adversely influences functional recovery after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 25, 1801–1806 (2017). https://doi.org/10.1007/s00167-016-4249-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-016-4249-0

Keywords

Search

Navigation