Evaluation of the safety and efficacy of primary total knee arthroplasty in patients with diabetes

Abstract

Objective To evaluate the perioperative safety and clinical efficacy of primary total knee arthroplasty in patients with diabetes.Methods Among the patients who were treated with total knee arthroplasty,there were 148 patients (168 knees) associated with diabetes.There were 32 male (36 knees) and 116 female (132 knees),the average age was 67.2 years (range,49-80 years).Osteoarthritis was diagnosed in 136 patients and rheumatoid arthritis was diagnosed in 12 patients.Different degrees of preoperative knee deformities were found in 116 knees.The average fasting blood glucose was 10.1±4.9 mmol/L at the admission time.The glycemic goals was set as:fasting blood glucose ＜ 7.8,2 h postpradndial blood glucose ＜ 10 mmol/L.Results After regular regulating of the blood glucose,the average preoperative fasting blood glucose was 7.2± 1.2 mmol/L,up to 9.9mmol/L.The average postprandial blood glucose was 11.0± 1.8 mmol/L.The mean duration of surgery was 72± 19 min,intraoperative blood loss was few and the mean drainage volume was 213.1±101.0 ml.The average total blood loss was 771.4±97.2 ml.Transfusion was needed in 12 patients (8.1％).Calf muscle venous thrombosis was found in 5 patients,while no deep vein thrombosis was found.The average length of stay was 13.0±4.4 days and the average follow-up time was 9.4±2.9 months.At the final follow-up time point,no prosthesis loosening was found and no revision was needed in any patients.The mean HSS scores increased from the preoperative 38.8± 14.3 to the postoperative 92.1±6.1,the excellent rate was 100％.The knee range of motion raised from preoperative 77.2°±19.3° to the postoperative 109.9°±11.1°.No deep infection was found.Conclusion Diabetic patients do not seem to have a significantly higher risk for infection and DVT after TKA.The early clinical outcomes of the patients with diabetes were satisfied.A comprehensive assessment of perioperative cardiopulmonary conditions should be conducted and active prevention of deep vein thrombosis and infection should be performed. Key words: Arthroplasty, replacement, knee; Diabetes mellitus; Perioperative period