Complications in diabetic patients undergoing revision total joint arthroplasty

Abstract

Background: The risks of complications in individuals with diabetes undergoing primary total joint arthroplasty are well discussed in the literature; however, little is written about their risks with revision procedures. This study evaluates complications surrounding revision arthroplasty in diabetics compared with controls. Methods: Six hundred and thirty-five patients underwent revision total hip and knee surgery since 2004. Sixty-five diabetics who underwent revision arthroplasty were compared to 65 matched controls. Demographics, comorbidities, and hemoglobin A1c (HgbA1c) levels were analyzed in comparison to complications encountered. Results: Of the 635 revision arthroplasty patients sampled, 10.2% (65/635) of patients had both diabetes and HgbA1c levels drawn. Thirty (46%) diabetic patients experienced 58 complications and required 25 additional procedures. Twenty-three (35%) controls experienced 35 complications and had 22 additional procedures. HgbA1c levels were a median (quartiles) of 5.90 (5.60–6.40) among diabetics without a complication, compared to 6.55 (6.10–7.20) among diabetics with at least one complication (P=0.0006). The number of complications was also strongly correlated with patient’s HbA1c (Spearman’s rho=0.417; P=0.0009). Diabetic patients had a higher complication rate and number of complications than controls. Diabetic patients were at higher risk of developing infections (18.4% vs. 4.6%; P=0.025), periprosthetic fractures (9.2% vs. 0%; P=0.028), and more severe rare complications (P=0.0029). Conclusions: The study suggests that diabetics with better glycemic control tend to have fewer complications. Diabetics undergoing revision arthroplasty appear to be at a higher risk of developing infections, periprosthetic fractures, and rare events than nondiabetics.