If you have diabetes, the risks of complications are higher if you undergo joint replacement surgery. But, how much higher and is there anything that you can do to reduce the risks?
Research into risk of complications among diabetic patients undergoing hip and knee replacement surgery
A recent study published in The Journal of Bone and Joint Surgery  explored the impact of diabetes on patients undergoing total knee and total hip replacement surgery. Researchers from UTMB in Texas and Drexel University in Pennsylvania looked at the files of patients who were part of the US federal health insurance programme, Medicare, and who underwent surgery in 2013 and 2014. They focused on complications and readmission rates among patients with diabetes, comparing them with patients who did not have the condition.
Aims of the study
Diabetes and arthritis often go hand in hand as both conditions are more common as people age. Researchers from UTMB and Drexel University point out in their study that between 48 and 56% of patients with diabetes develop osteoarthritis, which can lead to loss of mobility, pain and early mortality. In the US, joint replacement procedures account for the biggest proportion of Medicare spending among all inpatient procedures.
The study set out to consider perioperative and postoperative outcomes over a 90-day period among patients in four categories:
- Patients with no diabetes.
- Patients with controlled uncomplicated diabetes.
- Patients with controlled complicated diabetes.
- And patients with uncontrolled diabetes.
All of the patients reviewed in the study (521,230 in total) had received an elective (i.e. non-emergency) total hip or total knee replacement in 2013 and 2014.
Findings regarding risk of complications for joint replacement patients with diabetes
The study found that the risk of complications and readmission was higher in patients with diabetes compared to patients without.
Risk of complications: Complication rates were 2.1% for patients undergoing total knee replacements and 3.0% for patients having a total hip replacement. In the case of knee replacement surgery, the main complications were pulmonary embolism, pneumonia and periprosthetic joint or wound infection. For hip replacement patients the main complications were mechanical problems, pneumonia and infection.
Patients at greatest risk of developing complications after knee replacement were those with uncontrolled diabetes. Among hip replacement patients the odds of complications were highest for patients with controlled complicated diabetes. In both cases, the risk of complications was significantly higher among patients with diabetes compared to the no-diabetes group.
Risk of readmission: When it came to readmissions, the risk was also significantly higher among patients with diabetes compared to those without diabetes. The highest readmission rates in patients undergoing total knee replacement was for those with uncontrolled diabetes. In the case of total hip replacement, controlled complicated diabetes led to the greatest chance of being readmitted after surgery.
The researchers point out that, while their study was the first to examine complications and rates of readmission 90-days after surgery, other previous studies had found similar outcomes in patients 30-days after surgery.
What should I do if I have diabetes?
So, what are the implications of their research for patients with diabetes who need to undergo total hip or knee replacements?
It certainly does not mean you won’t be able to have a total hip or total knee replacement, however your surgeon will want to discuss your individual risks with you. It will be important, prior to surgery, to ensure that your diabetes is under control and your HbA1C levels will be checked at your pre-assessment appointment to ensure they are below 7%. Preparing for a hip or knee replacement is a good opportunity to review your diet and medication to ensure you achieve optimum levels of health prior to surgery. You can discuss this with your orthopaedic surgeon.
It is important to point out that the risks of complications or readmission are low with total knee or total hip replacements, whether or not you have diabetes, and this type of surgery has significant benefits in terms of movement, flexibility and quality of life.
If you are unsure, contact us to discuss your individual risks and benefits of undergoing joint replacement surgery.
 Impact of Diabetes on 90-Day Episodes of Care After Elective Total Joint Arthroplasty Among Medicare Beneficiaries, published in The Journal of Bone and Joint Surgery, 2020