title: Insulin Dependence Increases the Risk of Failure After Total Knee Arthroplasty in Morbidly Obese Patients.
abstract: The aims of this study were to compare the outcomes between nondiabetic (n=1284), type II diabetic (n=530), and insulin-dependent type II diabetic (n=164) morbidly obese (body mass index ≥40 kg/m(2)) patients undergoing primary total knee arthroplasty at 6-year follow-up. Patients with type II diabetes mellitus (DM) had similar outcomes when compared with non-DM patients. However, patients with insulin dependence had an increased risk of reoperation (hazard ratio [HR], 1.8; P=.005), revision (HR, 2; P=.02), and periprosthetic joint infection (HR, 2.1; P=.03), as well as decreased 10-year implant survivorship (84% vs 92%; P=.01) when compared to non-DM patients. Prospective studies should further evaluate outcomes and optimization measures within this population.
  
  
  METHODS
  Level III-prognostic study.
authors.affiliation: Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota.
authors.forename: Chad D
authors.initials: CD
authors.lastname: Watts
authors.affiliation: Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota.
authors.forename: Matthew T
authors.initials: MT
authors.lastname: Houdek
authors.affiliation: Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota.
authors.forename: Eric R
authors.initials: ER
authors.lastname: Wagner
authors.affiliation: Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota.
authors.forename: Matthew P
authors.initials: MP
authors.lastname: Abdel
authors.affiliation: Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Taunton
mesh_terms: D000368:Aged; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D015992:Body Mass Index; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000628:therapy; D005260:Female; D006801:Humans; D007328:Insulin / Q000627:therapeutic use*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications* / Q000628:therapy; D011379:Prognosis; D016016:Proportional Hazards Models; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D007328:Insulin
keywords: complication; diabetes; insulin dependence; morbid obesity; total knee arthroplasty