title: Inadequate pre-operative glycaemic control in patients with diabetes mellitus adversely influences functional recovery after total knee arthroplasty : Patients with impaired glycaemic control exhibit poorer functional outcomes at 1-year post-arthroplasty.
abstract: OBJECTIVE
  Whilst inadequate glycaemic control is associated with an increase in perioperative complications following total knee arthroplasty, the impact of glycaemic control in this at-risk patient group remains ill-defined. Identification of at-risk patients would allow targeted pre-operative glycaemic control intervention.
  
  
  METHODS
  One hundred consecutive patients with a diagnosis of diabetes mellitus and one hundred age, sex and BMI matched patients without diabetes undergoing total knee arthroplasty in a single institution were analysed between 2008 and 2013. Inadequate glycaemic control was defined as having an HbA1c of greater than 64 mmol/mol (8.0 % NGSP) measured within the 3 months before surgery. Patient demographics, diabetes management and complications of diabetes were recorded and used as explanatory variables to deliver a generalised linear model. This allows for relationships to be defined between change in patient-reported function (SF-36, WOMAC) and these explanatory variables.
  
  
  RESULTS
  The patient group with concomitant diabetes exhibited smaller improvements in WOMAC and SF-36 physical component summary at 1 year after knee arthroplasty. This effect was most pronounced in the subset of patients with inadequate glycaemic control recorded in the early pre-operative period.
  
  
  CONCLUSIONS
  Patients with diabetes, particularly those with inadequate glycaemic control, exhibit less improvement at 1 year following knee arthroplasty than patients without diabetes mellitus. Clinical focus on modulating this factor in this at-risk group is warranted.
  
  
  METHODS
  III.
authors: Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK. t.m.brock@doctors.org.uk.
authors: Timothy M
authors: TM
authors: Brock
authors: Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK.
authors: Mark
authors: M
authors: Shirley
authors: Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK.
authors: Michelle
authors: M
authors: Bardgett
authors: Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK.
authors: Mark
authors: M
authors: Walker
authors: Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK.
authors: David J
authors: DJ
authors: Deehan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D001786:Blood Glucose / Q000378:metabolism*; D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000097:blood*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D020127:Recovery of Function; D012189:Retrospective Studies
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin
keywords: Complications; Diabetes mellitus; Glycaemic control; Total knee arthroplasty