Early Physical Function Recovery and Quality of Life in Patients with Diabetes Mellitus after Minimally Invasive Total Knee Arthroplasty

Abstract

Background and Purpose: The population coexisted with knee osteoarthritis (OA) and diabetes mellitus (DM) requiring total knee arthroplasty (TKA) increases with aging. The new minimally invasive TKA (MIS-TKA) prevails due to its advantages. This study aimed to compare physical function recovery and quality of life (QOL) after MIS-TKA in patients with DM to those without, and to determine the factors influencing the postoperative outcomes. Methods: Ninety-three patients underwent MIS-TKA were recruited and divided into diabetic group and non-diabetic group (46 in diabetic group and 47 in non-diabetic group). The measurements were assessed before surgery and at 3-month follow-up, including range of motion (ROM) of knee flexion and quadriceps strength, physical function tests, physical activities, osteoarthritis index, and QOL. Results: There were significant between-group differences at preoperative and 3 months in quadriceps strength of non-operated side (p=0.007), 6-minute walk test distances (p=0.001), and role-physical (p=0.021) and general health domains (p=0.039) of QOL after adjustment for body mass index. The 3-month follow-up 6MWT distances were associated with preoperative 6MWT distances, postoperative knee flexion ROM and quadriceps strength of non-operated side, and the non-diabetic group (adjusted R^2=72.6%, p＜0.001). However, diabetes was not a major independent factor associated with postoperative physical function and QOL while adjusting for covariates. Conclusion: Compared to patients without DM, patients with DM had worse physical function and QOL at 3-month follow- up. Postoperative knee flexion ROM, quadriceps strength, and preoperative physical function status were major predictors of postoperative physical function and QOL in patients receiving MIS-TKA.