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Slight differences reported in outcomes of diabetic, nondiabetic TKA patients
Uncontrolled diabetes can cause problems in bone healing and wounds. That can affect the success of a TKA.
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SEOUL — An investigation performed here revealed that diabetes patients undergoing total knee arthroplasty fared somewhat comparably to nondiabetic patients, but those who failed to control their blood sugar ran a greater risk of some complications.
Seung-Baik Kang, MD, of Seoul Metropolitan Boramae Hospital, performed 601 total knee arthroplasty (TKA) procedures on 373 patients between 1996 and 2001. From this series, 74 TKAs were performed in 45 patients with diabetes. All of the patients in the diabetes group had type II diabetes mellitus and osteoarthritis of the knee.
The average follow-up was 49 months, Kang said at the 15th Triennial Congress of the Asia Pacific Orthopaedic Association, here.
Kang and his colleagues compared results of the diabetic and nondiabetic groups using the Hospital for Special Surgery (HSS) and Knee Society clinical and radiological scoring systems. They also compared radiological loosening and perioperative complications.
"We also evaluated and recorded plasma hemoglobin A1c (HbA1c) levels in all patients with diabetes," he said.
According to Kang, the knee scores and pain scores were significantly higher in the diabetes group postoperatively (P=.0048 and P=.0035, respectively). However, the HSS scores and overall function scores were higher in the nondiabetes group postoperatively (P=.0012 and P=.0016, respectively).
"We also saw that the rate of superficial wounds was slightly higher in the diabetes group compared to the non-diabetes patients (8.1% vs. 0.6%, respectively)," he said.
Two deep infections (2.7%) occurred in the diabetes group vs. three deep infections (0.9%) in the nondiabetes group, according to the abstract. However, this difference was not significant.
Kang stressed the importance of diabetic patients maintaining tight control over their blood sugar.
"The HbA1c level is usually high in superficial wound complication cases and in deep infection cases among the diabetic patients," he said. Likewise, "Consistently high blood sugar levels can cause harm to bone healing and remodeling."
Ultimately, "High HbA1c readings might be one of the best indicators to tell us if a patient is at risk for TKA [problems]."
For more information:
- Kang S-B, Yoon K-S, Han HS, Jo YJ. The outcome of knee arthroplasty in diabetics. F039-5. Presented at the 15th Triennial Congress of the Asia Pacific Orthopaedic Association. Sept. 9-13, 2007. Seoul.