RESEARCH - Diabetes type affects outcomes after hip and knee arthroplasty

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Diabetes type affects outcomes after hip and knee arthroplasty

By Reuters Health

March 6, 2008

NEW YORK (Reuters Health), Mar 6 - Type 1 diabetics who undergo total

hip and knee arthroplasty generally fare worse than their type 2

counterparts who in turn do worse than nondiabetic patients, according

to study findings presented this week at the annual meeting of the

American Academy of Orthopaedic Surgeons (AAOS) in San Francisco.

" The biggest finding was that diabetes predicted higher complication

rates and this is obviously not a huge surprise, " senior researcher

Dr. P. Bolognesi, from Duke University Medical Center in

Durham, NC, told Reuters Health.

Overall, type 1 diabetics did worse than type 2 diabetics, he added.

However, the worst outcomes were seen in the subgroup of type 2

diabetics with uncontrolled disease. " We are not aware of any other

data demonstrating this influence of (diabetes) type in hip and knee

arthroplasty patients. "

The findings are based on an analysis of data for 65,769 diabetic

patients who underwent joint replacement surgery and were entered in

the Nationwide Inpatient Sample from 1988 to 2003.

Compared with type 2 diabetics, type 1 diabetics had significantly

longer hospital stays and higher inflation-adjusted costs after

surgery (p < 0.001). Type 1 diabetics were also at increased risk for

MI, pneumonia, urinary tract infection, postoperative hemorrhage,

wound infection, and death (p < 0.02).

" Physicians need to be aware of the fact that these patients do worse

across the board and do everything they can to minimize complications

(and be ready to address them as they will likely occur), " Dr.

Bolognesi emphasized. " Our control analysis suggests that we could

also help these patients by making sure (their blood glucose levels

are) controlled preoperatively and during the perioperative period. "

By J. Brown, M.D.

Last Updated: 2008-03-05 10:01:53 -0400 (Reuters Health)

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