Clinical Characteristics of Patients with Type 2 Diabetes Mellitus Receiving a Primary Total Knee or Hip Arthroplasty

Annalisa Na, Laurie Jansky, Zbigniew Gugala, Annalisa Na, Laurie Jansky, Zbigniew Gugala

Abstract

Aim: The purpose of this study is to explore clinical characteristics of patients with T2DM receiving a primary knee (TKA) or hip (THA) arthroplasty to patients without T2DM receiving a TKA or THA and patients with T2DM with no history of osteoarthritis (OA).

Methods: The study included a retrospective database review of 500 consecutive primary TKA or THA identified with ICD-9 codes and 100 consecutive T2DM patients. Patients who received a TKA or THA were screened for inclusion and exclusion and divided into with or without T2DM groups. A comparison group of patients with T2DM only without arthroplasty was screened to exclude patients with a history of OA or arthroplasty. All groups were compared based on demographic and relevant comorbidity differences. OA characteristics, including OA and previous arthroplasty of the involved and contralateral joints, were compared between patients with and without T2DM receiving a TKA or THA. Finally, patients with T2DM with and without TKA or THA were compared for T2DM differences.

Results: Study results found that among those receiving a primary arthroplasty, patients with T2DM were more likely to be obese and older and reported cardiovascular, urinary, dyslipidemia, and peripheral neuropathy than those with T2DM. Among the T2DM individuals, those receiving an arthroplasty surgery were older and obese and more likely to report peripheral neuropathy; however, those with T2DM with no OA were more likely to report atherosclerosis and cardiovascular disease. Within the arthroplasty subgroup of individuals with T2DM, those requiring antidiabetic medication were 4.5 times more likely to have contralateral OA or arthroplasty.

Conclusions: The results of this study suggest that patients with T2DM requiring a primary arthroplasty are a unique subgroup that requires careful considerations as they are often older, have obesity, and specific comorbidities predisposing to worse postoperative outcomes than their non-T2DM arthroplasty counterparts. Therefore, clinical practice and future studies must consider strategies that would limit OA and arthroplasty management delays while accounting for comorbidities and patient characteristics.

Conflict of interest statement

None of the authors has any financial or personal relationships with other people or organizations that might pose a conflict of interest in connection with the submitted article.

Copyright © 2019 Annalisa Na et al.

Figures

Figure 1
Figure 1
Chart review flow. Charts were screened for inclusion and exclusion criteria of patients receiving a total hip or knee arthroplasty withand without type 2 diabetes mellitus (T2DM) and patients with T2DM without a history of osteoarthritis (OA) or arthroplasty.
Figure 2
Figure 2
Radar plot showing proportions of individual characteristics, comorbidities, and arthritis per type 2 diabetes mellitus (T2DM) status among those receiving a primary total knee arthroplasty (TKA). Vertices of radar plot represent group proportion of variables for patient characteristics (upper right quadrant of radar plot), comorbidities (bottom half of quadrant), and OA and arthroplasty characteristics of joint involvement (upper left quadrant of radar plot); ∗P ≤ 0.05; ∗∗P ≤ 0.01.
Figure 3
Figure 3
Radar plot showing the proportion of individual characteristics, comorbidities, and arthritis per type 2 diabetes mellitus (T2DM) status among those receiving a primary total hip arthroplasty (THA). Vertices of radar plot represent proportion per group of each variable for patient characteristics (upper right quadrant of radar plot), comorbidities (bottom half of quadrant), and OA and arthroplasty characteristics of joint involvement (upper left quadrant of radar plot); ∗P ≤ 0.05; ∗∗P ≤ 0.01.
Figure 4
Figure 4
Relationship between body mass index (BMI) and age in years at the time of arthroplasty surgery among patients with and without type 2 diabetes mellitus (T2DM). – indicates cut-off for obesity defined as BMI≥30 kg/m2.
Figure 5
Figure 5
Radar plot showing proportion of individual characteristics, comorbidities, and type 2 diabetes mellitus (T2DM) differences with and without arthroplasty. Vertices of radar plot represent proportion per group of each variable for patient characteristics (upper right quadrant of radar plot), comorbidities (bottom half of quadrant), and OA and arthroplasty characteristics of joint involvement (upper left quadrant of radar plot). TKA = total knee arthroplasty; THA = total hip arthroplasty; ∗P ≤ 0.05; ∗∗P ≤ 0.01.
Figure 6
Figure 6
Group breakdown of contralateral joint involvement per type 2 diabetes mellitus (T2DM) and antidiabetic intervention status.

References

    1. Mizner R. L., Petterson S. C., Clements K. E., Zeni J. A., Irrgang J. J., Snyder-Mackler L. Measuring functional improvement after total knee arthroplasty requires both performance-based and patient-report assessments: a longitudinal analysis of outcomes. The Journal of Arthroplasty. 2011;26(5):728–737. doi: 10.1016/j.arth.2010.06.004.
    1. Giori N. J., Ellerbe L. S., Bowe T., Gupta S., Harris A. H. S. Many diabetic total joint arthroplasty candidates are unable to achieve a preoperative hemoglobin A1c goal of 7% or less. The Journal of Bone & Joint Surgery. 2014;96(6):500–504. doi: 10.2106/jbjs.l.01631.
    1. Stürmer T., Brenner H., Brenner R. E., Günther K. P. Non-insulin dependent diabetes mellitus (NIDDM) and patterns of osteoarthritis. The Ulm osteoarthritis study. Scandinavian Journal of Rheumatology. 2001;30(3):169–171. doi: 10.1080/030097401300162969.
    1. Leaverton P. E., Peregoy J., Fahlman L., Sangeorzan E., Barrett J. P. Does diabetes hide osteoarthritis pain? Medical Hypotheses. 2012;78(4):471–474. doi: 10.1016/j.mehy.2012.01.008.
    1. Doury-Panchout F., Metivier J.-C., Fouquet B. Kinesiophobia negatively influences recovery of joint function following total knee arthroplasty. European Journal of Physical and Rehabilitation Medicine. 2015;51(2):155–161.
    1. Peter W. F., Dekker J., Tilbury C., et al. The association between comorbidities and pain, physical function and quality of life following hip and knee arthroplasty. Rheumatology International. 2015;35(7):1233–1241. doi: 10.1007/s00296-015-3211-7.
    1. Piva S. R., Susko A. M., Khoja S. S., Josbeno D. A., Fitzgerald G. K., Toledo F. G. S. Links between osteoarthritis and diabetes: implications for management from a physical activity perspective. Clinics in Geriatric Medicine. 2015;31(1):67–87. doi: 10.1016/j.cger.2014.08.019.
    1. Hawker G. A., Croxford R., Bierman A. S., et al. Osteoarthritis-related difficulty walking and risk for diabetes complications. Osteoarthritis and Cartilage. 2017;25(1):67–75. doi: 10.1016/j.joca.2016.08.003.
    1. Nuesch E., Dieppe P., Reichenbach S., Williams S., Iff S., Juni P. All cause and disease specific mortality in patients with knee or hip osteoarthritis: population based cohort study. BMJ. 2011;342:p. d1165. doi: 10.1136/bmj.d1165.
    1. Lalani A., Lee L., Pitta M., Westrich G., Lyman S. Age-related decline in patient-reported outcomes 2 and 5 years following total hip arthroplasty. The Journal of Arthroplasty. 2019;34(9):1999–2005. doi: 10.1016/j.arth.2019.02.023.
    1. Pitta M., Khoshbin A., Lalani A., et al. Age-related functional decline following total knee arthroplasty: risk adjustment is mandatory. The Journal of Arthroplasty. 2019;34(2):228–234. doi: 10.1016/j.arth.2018.09.046.
    1. Chew B. H., Shariff Ghazali S., Ismail M., Haniff J., Bujang M. A. Age ≥ 60 years was an independent risk factor for diabetes-related complications despite good control of cardiovascular risk factors in patients with type 2 diabetes mellitus. Experimental Gerontology. 2013;48(5):485–491. doi: 10.1016/j.exger.2013.02.017.
    1. Cordero-Ampuero J., Dios M. What are the risk factors for infection in hemiarthroplasties and total hip arthroplasties? Clinical Orthopaedics and Related Research. 2010;468(12):3268–3277. doi: 10.1007/s11999-010-1411-8.
    1. Goldstein D. T., Durinka J. B., Martino N., Shilling J. W. Effect of preoperative hemoglobin A(1c) level on acute postoperative complications of total joint arthroplasty. The American Journal of Orthopedics. 2013;42(10):E88–E90.
    1. Barbour S. J., Er L., Djurdjev O., Karim M., Levin A. Differences in progression of CKD and mortality amongst Caucasian, Oriental Asian and South Asian CKD patients. Nephrology, Dialysis, Transplantation. 2010;25(11):3663–3672. doi: 10.1093/ndt/gfq189.
    1. Blanco F. J., Ruiz-Romero C. Metabolomic characterization of metabolic phenotypes in OA. Nature Reviews Rheumatology. 2012;8(3):130–132. doi: 10.1038/nrrheum.2012.11.
    1. Saucedo J. M., Marecek G. S., Wanke T. R., Lee J., Stulberg S. D., Puri L. Understanding readmission after primary total hip and knee arthroplasty: who’s at risk? The Journal of Arthroplasty. 2014;29(2):256–260. doi: 10.1016/j.arth.2013.06.003.
    1. Soohoo N. F., Farng E., Lieberman J. R., Chambers L., Zingmond D. S. Factors that predict short-term complication rates after total hip arthroplasty. Clinical Orthopaedics and Related Research. 2010;468(9):2363–2371. doi: 10.1007/s11999-010-1354-0.
    1. King K. B., Findley T. W., Williams A. E., Bucknell A. L. Veterans with diabetes receive arthroplasty more frequently and at a younger age. Clinical Orthopaedics and Related Research. 2013;471(9):3049–3054. doi: 10.1007/s11999-013-3026-3.
    1. Allen M. D., Major B., Kimpinski K., Doherty T. J., Rice C. L. Skeletal muscle morphology and contractile function in relation to muscle denervation in diabetic neuropathy. Journal of Applied Physiology. 2014;116(5):545–552. doi: 10.1152/japplphysiol.01139.2013.
    1. Allen M. D., Choi I. N. H. O., Kimpinski K., Doherty T. J., Rice C. L. Short report Moyor unit loss and weakness in association with diabetic neuropathy in humans. Muscle & Nerve. 2013;48:298–300. doi: 10.1002/mus.23792.
    1. Schafer A. L., Vittinghoff E., Lang T. F., et al. Fat infiltration of muscle, diabetes, and clinical fracture risk in older adults. The Journal of Clinical Endocrinology and Metabolism. 2010;95(11):E368–E372. doi: 10.1210/jc.2010-0780.
    1. Burner T., Gohr C., Mitton-Fitzgerald E., Rosenthal A. K. Hyperglycemia reduces proteoglycan levels in tendons. Connective Tissue Research. 2012;53(6):535–541. doi: 10.3109/03008207.2012.710670.
    1. Brandt K. D. Neuromuscular aspects of osteoarthritis: a perspective. Novartis Foundation Symposium. 2004;260:49–58. doi: 10.1002/0470867639.ch4.

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