Factors affecting outcome after total knee arthroplasty in patients with diabetes mellitus.
OBJECTIVE
To compare the clinical outcome and complications following total knee arthroplasty (TKA) in diabetic and non-diabetic patients, and to identify diabetes-related risk factors for negative outcomes.


METHODS
222 primary TKAs in patients with diabetes were evaluated using Knee Society scores and Hospital for Special Surgery score. Postoperative complications were reviewed retrospectively. The mean follow-up was 53.2 months. The effect of diabetes-related factors and comparison with a matched control group were analyzed statistically.


RESULTS
Significant improvements were noted in all the scores after TKA (p < 0.05). There was no statistical difference in clinical sores between the diabetic and non-diabetic patients. In multivariate analysis associating age, gender and body mass index with pain and knee score at the latest follow-up, the average knee scores in normal and overweight group were found to be significantly higher than those in the obese group. The diabetic patients had an increased overall incidence of postoperative complications (17.6%) compared with the control group (8.1%) (p < 0.05). Particularly, the rate of wound complications such as skin necrosis, bulla formation or erythema with drainage was higher in the diabetic group (p < 0.05). Diabetes-related factors did not influence the incidence of complications. Associated diseases were the only significant risk factors correlated with wound complications and meniscal bearing dislodgement.


CONCLUSIONS
Patients with diabetes can benefit from TKA, even though diabetic patients are at an increased risk for overall postoperative and wound complications. Preoperative factors such as obesity and associated diseases may adversely affect the clinical outcome of TKA in diabetic patients.
Moon
Hong Kyo
HK
Department of Orthopaedic Surgery, Severance Hospital, Yonsei University College of Medicine, 250 Seongsanno, Seodaemun-gu, Seoul 120-752, Korea.
Han
Chang Dong
CD
Yang
Ick Hwan
IH
Cha
Bong Soo
BS
D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee; D003920:Diabetes Mellitus; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D016896:Treatment Outcome