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Getting New Knees? Be Cautious if you have Diabetes
March 07, 2008
By: Chris Messina for Knee1
Patients with diabetes who undergo either knee replacement surgery are more likely to suffer complications than patients without diabetes. Those results were recently announced at the 75th Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS). In addition, patients with type 1 diabetes are more likely to have complications than patients with type 2 diabetes following the same surgery.
There are an estimated 20 million people in the United States with diabetes. Half are over the age of 60. Half the people with diabetes have some form of arthritis. Hip and knee replacements are done largely to relieve arthritis pain, so it is important to understand that people with diabetes, especially type 1, may have a longer, more costly, and more complicated hospital stay than other patients.
Complications in patients with type 1 may be due to the differences in the two diabetes types. Diabetes occurs when the body does not regulate glucose (sugar) or produce insulin appropriately. Type 1 diabetes patients are insulin dependent. Although, this form of the disease usually develops in children and young adults, onset can happen at any age. There are many risks and complications associated with type 1 diabetes.
Type 2 diabetes affects more people. About 90 percent of those diagnosed with the disease are type 2 and are generally older. Many people with type 2 diabetes may control the disease with diet and exercise, adding oral medications as it becomes more difficult to maintain adequate control. “Patients with type 1 have to be rigidly managed while in the hospital and are more complicated to treat,” said Michael P. Bolognesi, MD, author of the AAOS study. Bolognesi is the director of adult reconstruction at Duke University Medical Center and an AAOS fellow. “Doctors will have to be more in tune with patients who have both type 1 and type 2 before and after surgery.”
The study is based on the results of the Nationwide Inpatient Sample (NIS) study. This study tracked 65,769 patients who had diabetes and had joints replaced. Statistical analysis was used to compare 8,728 patients with type 1 diabetes and 57,041 patients with type 2 diabetes. Common complications, mortality, and hospital stays were also evaluated.
The results found that type 1 patients routinely stayed longer in the hospital. They also had significant increases in complications, including heart attacks, pneumonia, urinary tract and wound infections, as well as post-operative bleeding. Overall post-surgical mortality also was found to increase for type1 patients as well.
As a specific example, wound infections at 0.08% (8 per 10,000) were significantly higher in those with type 1 diabetes than those with type 2. The largest increase in risk found between the two groups was in the area of heart attacks. This risk while small overall at 0.06% (6 per 10,000 cases) for those with type 1 diabetes still represented a three-fold increase over those patients with type 2 diabetes.
This problem is expected to increase rapidly as more patients with diabetes require hip and knee replacement procedures. If doctors understand and anticipate the risks to these patients who undergo hip and knee replacements, better post-surgery outcomes can be expected. For example, people with any type of diabetes, did better after surgery if they managed their disease well before the surgery.
“The study further supports that people with good control of their diabetes fare better than those whose disease is uncontrolled. Clearly, with those patients who have good control, there is a decrease in their complications and risks,” Dr. Bolognesi said. “Doctors must continue to communicate their post-surgery concerns to patients with diabetes, then both doctor and patient will be more likely to be aware of warnings signs.”
|Prior to surgery:|
Consult with your primary care doctor
See if a Certified Diabetes Educator (CDE) can provide you with additional information
If overweight, shed as many extra pounds as possible
Keep your blood sugar regulated
Take your prescribed medications as directed by your doctor
Review the real risks of post-surgical complications
Print this article and discuss it with your surgeon
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