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Outcomes following hip and knee replacement in diabetic versus nondiabetic patients and well versus poorly controlled diabetic patients: a prospective cohort study

Research output: Contribution to journalArticle

Original languageEnglish
Pages (from-to)399-405
Number of pages7
JournalActa Orthopaedica
Volume89
Issue number4
Early online date29 May 2018
DOIs
DateAccepted/In press - 12 Apr 2018
DateE-pub ahead of print - 29 May 2018
DatePublished (current) - 4 Jul 2018

Abstract

Background and purpose — The impact of diabetes and glycemic control before joint replacement on clinical and patient-reported outcomes is unclear. We compared pain, function, complications, and length of hospital stay in diabetic and nondiabetic patients receiving primary total hip (THR) or knee replacement (TKR) and compared these outcomes in patients with poorly controlled versus well-controlled diabetes. Patients and methods — We conducted a prospective cohort study of patients undergoing primary THR (n = 300) or TKR (n = 287) for osteoarthritis. Self-reported diabetes and glycemic control (HbA1c ≤ or >7%) extracted from medical notes were used. Adjusted comparisons were performed with generalized linear models including body mass index (BMI) and comorbidities. Results — Diabetes prevalence was 11% (THR 8%; TKR 14%). Diabetic patients were more likely to have a higher BMI and greater number of comorbidities. The median length of hospital stay was 1 day longer in diabetic patients (p = 0.004), but this attenuated after adjustments for BMI and comorbidities (p = 0.3). Inpatient pain was greater for diabetic patients but attenuated following adjustment. The 12-month postoperative WOMAC subscales were similar by diabetes status following adjustment. There was little evidence of difference in outcomes according to glycemic control. Interpretation — The associations between diabetes and worse postoperative outcomes in patients undergoing THR or TKR for osteoarthritis appear to be predominantly due to associated obesity and comorbidities. In diabetic patients there is little evidence of association between postoperative outcome and preoperative glycemic control. The underlying mechanisms and causal pathways of obesity, diabetes, and multimorbidity that lead to worse outcomes after joint replacement are not well known.

    Structured keywords

  • Centre for Surgical Research

    Research areas

  • Hip , Knee, arthroplasty, joint replacement, diabetes, glycemic control, body mass index, comorbitiy, Cohort Study

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    Rights statement: This is the final published version of the article (version of record). It first appeared online via Taylor & Francis at https://www.tandfonline.com/doi/full/10.1080/17453674.2018.1477708 . Please refer to any applicable terms of use of the publisher.

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    Licence: CC BY-NC

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