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Joint replacement patients with diabetes greatly benefit from controlled glucose

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Patients with diabetes undergoing total joint replacement often are at a higher risk of experiencing complications after surgery due to various pre-existing health conditions.

According to a new study published in The Journal of Bone and Joint Surgery, those complications are less likely to occur when a patient with diabetes has glucose levels under control.

“We found that controlled glucose levels really do make a difference for the patient,” said study co-author Milford Marchant Jr., MD, an orthopaedic surgeon who conducted the study with colleagues at the Adult Reconstruction Section at Duke University Medical Center.

The study found that patients with uncontrolled glucose levels were:

• More than three times as likely to experience a stroke or death after joint replacement surgery.
• About twice as likely to experience postoperative bleeding and infection.

The researchers reviewed data from a national healthcare database looking at more than one million patients who had total joint replacement surgery from 1988 to 2005. They compared surgical outcomes in patients with uncontrolled glucose levels to those who had controlled glucose levels and those patients who did not have diabetes.

“It did not matter if the patient had type 1 or type 2 diabetes,” Marchant said. “Regardless of diabetes type, we found that patients had fewer complications after surgery if their glucose level was controlled before, during and after surgery.”

Patients with diabetes and uncontrolled glucose were more likely to experience surgical complications, infection, blood transfusions and longer hospitals stays.

Approximately 8% of patients undergoing total hip and knee replacement in the United States have diabetes, according to the American Diabetes Association.

"It is crucial that patients have glucose levels well managed before, during and after surgery because it reduces the potential of having a complication," Marchant said. "This is the responsibility of both the patient and the surgeon, and it should be a priority."

Marchant MH. J Bone Jt Surg (Am). 2009;91:1621-1629.