The Impact of Glycemic Control and Diabetes Mellitus on Perioperative Outcomes After Total Joint Arthroplasty

Marchant Jr., Milford H.; Viens, Nicholas A.; Cook, Chad; Vail, Thomas Parker; Bolognesi, Michael P.
July 2009
Journal of Bone & Joint Surgery, American Volume;Jul2009, Vol. 91-A Issue 7, p1621
Academic Journal
Background: As the prevalence of diabetes mellitus in people over the age of sixty years is expected to increase, the number of diabetic patients who undergo total hip and knee arthroplasty should be expected to increase accordingly. In general, patients with diabetes are at increased risk for adverse events following arthroplasty. The goal of the present study was to determine whether the quality of preoperative glycemic control affected the prevalence of in-hospital pen- operative complications following lower extremity total joint arthroplasty. Methods: From 1988 to 2005, the Nationwide Inpatient Sample recorded over 1 million patients who underwent joint replacement surgery. The present retrospective study compared patients with uncontrolled diabetes mellitus (n = 3973), those with controlled diabetes mellitus (n = 105,485), and those without diabetes mellitus (n = 920,555) with regard to common surgical and systemic complications, mortality, and hospital course alterations. Additional strati- fication compared the effects of glucose control among patients with Type-I and Type-II diabetes. Glycemic control was determined by physician assessments on the basis of the American Diabetes Association guidelines with use of a combination of patient self-monitoring of blood-glucose levels, the hemoglobin A1c level, and related comorbidities. Results: Compared with patients with controlled diabetes mellitus, patients with uncontrolled diabetes mellitus had a significantly increased odds of stroke (adjusted odds ratio = 3.42; 95% confidence interval = 1.87 to 6.25; p < 0.001), urinary tract infection (adjusted odds ratio = 1.97; 95% confidence interval = 1.61 to 2.42; p < 0.001), ileus (adjusted odds ratio = 2.47; 95% confidence interval = 1.67 to 3.64; p < 0.001), postoperative hemorrhage (adjusted odds ratio = 1.99; 95% confidence interval = 1.38 to 2.87; p < 0.001), transfusion (adjusted odds ratio = 1.19; 95% confidence interval = 1.04 to 1.36; p = 0.011), wound infection (adjusted odds ratio = 2.28; 95% confidence interval = 1.36 to 3.81; p = 0.002), and death (adjusted odds ratio = 3.23; 95% confidence interval = 1.87 to 5.57; p < 0.001). Patients with uncontrolled diabetes mellitus had a significantly increased length of stay (almost a full day) as compared with patients with controlled diabetes (p < 0.0001). All patients with diabetes had significantly increased inflation-adjusted postoperative charges when compared with nondiabetic patients (p < 0.0001). Conclusions: Regardless of diabetes type, patients with uncontrolled diabetes mellitus exhibited significantly increased odds of surgical and systemic complications, higher mortality, and increased length of stay during the index hospitalization following lower extremity total joint arthroplasty.


Related Articles

  • What is the failure rate after lumbar disc replacement surgery? Feise, Ron // Journal of the American Chiropractic Association;Jan/Feb2009, Vol. 46 Issue 1, p17 

    The article focuses on a study which examined the effect of arthrodesis or total disc arthroplasty on lumbar adjacent segment degeneration (ASDeg). Studies conducted from 1996 to 2006 were assessed. It was concluded that data from low-quality studies could not help in finding out which surgical...

  • Conflict of Interest in the Assessment of Thromboprophylaxis After Total Joint Arthroplasty. Young-Kyun Lee; Chin Youb Chung; Kyung-Hoi Koo; Kyotmg Min Lee; Hyung-Min li; Moon Seok Park // Journal of Bone & Joint Surgery, American Volume;1/4/2012, Vol. 94-A Issue 1, p27 

    Background: The choice of modalities for thromboprophylaxis after total joint arthroplasty is controversial. To address this issue, an evidence-based review of previous studies was performed. The characteristics of the studies selected for review can affect the final conclusion of an...

  • CLASSIFICATION AND AN ALGORITHMIC APPROACH TO THE RECONSTRUCTION OF FEMORAL DEFICIENCY IN REVISION TOTAL HIP ARTHROPLASTY. Della Valle, Craig J.; Paprosky, Wayne G. // Journal of Bone & Joint Surgery, American Volume;Nov2003 Supplement 4, Vol. 85-A, p1 

    The article reports on a study which examines a system for the classification of femoral deficiency as well as an algorithmic approach to femoral reconstruction in revision total hip arthroplasty. The authors of the study reviewed seventy-one femoral revision arthroplasties. The results showed...

  • Influence of cementless femoral stems inserted in varus on functional outcome in primary total hip arthroplasty. de Beer, Justin; McKenzie, Scott; Hubmann, Matthias; Petruccelli, Danielle; Winemaker, Mitchell // Canadian Journal of Surgery;Dec2006, Vol. 49 Issue 6, p407 

    Introduction: Historically, cemented total hip arthroplasty (THA) femoral stems inserted in varus have yielded poor clinical results. Few studies to date have addressed the question of the effects of varus alignment on cementless stems. We conducted a retrospective review of 125 uncemented THA...

  • USE OF A SENTINEL PIN AS A GUIDE TO ACETABULAR COMPONENT ANTEVERSION IN TOTAL HIP ARTHROPLASTY. Goldstein, Wayne M.; Jimenez, Matthew L.; Gordon, Alexander C.; Branson, Jill Jasperson; Berland, Kimberly // Journal of Bone & Joint Surgery, American Volume;Dec2006 Supplement 4, Vol. 88-A, p97 

    The article presents information on a study in which researchers determine the use of a pin during total hip arthroplasty. According to the study, surgeons can frequently used a pin during total hip arthroplasty in the pelvis to facilitate intraoperative limb-length measurement. The study...

  • The Epidemiology of Bearing Surface Usage in Total Hip Arthroplasty in the United States. Bozic, Kevin J.; Kurtz, Steven; Lau, Edmund; Ong, Kevin; Chiu, Vanessa; Vail, Thomas P.; Rubash, Harry E.; Berry, Daniel J. // Journal of Bone & Joint Surgery, American Volume;Jul2009, Vol. 91-A Issue 7, p1614 

    Background: Hard-on-hard bearings offer the potential to improve the survivorship of total hip arthroplasty implants. However, the specific indications for the use of these advanced technologies remain controversial. The purpose of this study was to characterize the epidemiology of bearing...

  • How Reliable is the Safe Zone of Hardinge Approach for Superior Gluteal Nerve? Bülbül, Murat; Ayanoğlu, Semih; Öztürk, Kahraman; İmren, Yunus; Esenyel, Cem; Yeşıltepe, Rıdvan; Gürbüz, Hakan // Medical Journal of Trakya University / Trakya Universitesi Tip F;2009, Vol. 26 Issue 2, p134 

    Objectives: Anterolateral Hardinge approach is one of the most common approaches used for total hip arthroplasty. Superior gluteal nerve is the main motor nerve of abductor mechanism of gluteus medius and tensor fascia lata muscles, where the injury to this nerve manifests itself as...

  • The outcome of the cementless tapered SL-Plus stem: an analysis of arthroplasty register data. Labek, Gerold; Kovac, Simon; Levasic, Vesna; Janda, Wolfgang; Zagra, Luigi // International Orthopaedics;Jun2012, Vol. 36 Issue 6, p1149 

    Purpose: The aim of this study is to evaluate the outcome of the cementless SL-Plus stem in worldwide arthroplasty register datasets. Methods: A structured analysis was conducted the registered data about the SL-Plus stem manufactured by Smith&Nephew including published data from Australia as...

  • The accuracy of digital templating: a comparison of short-stem total hip arthroplasty and conventional total hip arthroplasty. Schmidutz, Florian; Steinbrück, Arnd; Wanke-Jellinek, Lorenz; Pietschmann, Matthias; Jansson, Volkmar; Fottner, Andreas // International Orthopaedics;Sep2012, Vol. 36 Issue 9, p1767 

    Purpose: Selection of the correct femoral stem size is crucial in total hip arthroplasty for an uncomplicated implantation and good initial stability. Pre-operative templating has been shown to be a valuable tool in predicting the correct implant size. For short-stem total hip arthroplasty...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics