title: The influence of diabetes mellitus on the post-operative outcome of elective primary total knee replacement: a systematic review and meta-analysis.
abstract: Total knee replacement (TKR) is an effective method of treating end-stage arthritis of the knee. It is not, however, a procedure without risk due to a number of factors, one of which is diabetes mellitus. The purpose of this study was to estimate the general prevalence of diabetes in patients about to undergo primary TKR and to determine whether diabetes mellitus adversely affects the outcome. We conducted a systematic review and meta-analysis according to the Meta-analysis Of Observational Studies in Epidemiology (MOOSE) guidelines. The Odds Ratio (OR) and mean difference (MD) were used to represent the estimate of risk of a specific outcome. Our results showed the prevalence of diabetes mellitus among patients undergoing TKR was 12.2%. Patients with diabetes mellitus had an increased risk of deep infection (OR = 1.61, 95% confidence interval (CI), 1.38 to 1.88), deep vein thrombosis (in Asia, OR = 2.57, 95% CI, 1.58 to 4.20), periprosthetic fracture (OR = 1.89, 95% CI, 1.04 to 3.45), aseptic loosening (OR = 9.36, 95% CI, 4.63 to 18.90), and a poorer Knee Society function subscore (MD = -5.86, 95% CI, -10.27 to -1.46). Surgeons should advise patients specifically about these increased risks when obtaining informed consent and be meticulous about their peri-operative care.
authors.affiliation: Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: Z
authors.initials: Z
authors.lastname: Yang
authors.affiliation: Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: H
authors.initials: H
authors.lastname: Liu
authors.affiliation: Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: X
authors.initials: X
authors.lastname: Xie
authors.affiliation: Department of Orthopedics , West China Hospital, Sichuan University, Chengdu, China.
authors.forename: Z
authors.initials: Z
authors.lastname: Tan
authors.affiliation: Chinese Evidence-Based Medicine Centre, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: T
authors.initials: T
authors.lastname: Qin
authors.affiliation: Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: P
authors.initials: P
authors.lastname: Kang
mesh_terms: D001168:Arthritis / Q000150:complications / Q000601:surgery*; D019645:Arthroplasty, Replacement, Knee; D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000453:epidemiology; D017558:Elective Surgical Procedures; D006801:Humans; D015995:Prevalence; D016896:Treatment Outcome
keywords: Diabetes mellitus; Functional assessment; Meta-analysis; Post-operative complications; Systematic review; Total knee replacement