Insulin dependence increases the risk of postoperative complications and inferior outcome but not the survivorship of total joint arthroplasty among diabetic population: a systematic review and meta-analysis

Abstract

Diabetes mellitus (DM) has been associated with poorer outcomes in total hip arthroplasty (THA) and total knee arthroplasty (TKA). However, it is not clear if insulin-dependent diabetes mellitus (IDDM) patients display more perioperative complications and a worse clinical outcome compared to patients with non-insulin-dependent diabetes mellitus (NIDDM). Medline, Scopus, and the Cochrane library were systematically searched from inception to December 2020 to identify studies evaluating the results of THA and TKA in IDDM and NIDDM patients. The primary outcomes of the review were the surgical and systemic complications, 30-day mortality and readmission, and revision arthroplasty. Secondary outcomes were the survival of the prosthetic joints and the Knee Society Score (KSS). Thirteen studies with 54,215 patients were included in the review. IDDM patients showed a greater risk for developing periprosthetic joint infection (p = 0.02), wound complications (p = 0.01), 30-day readmission (p <0.01) and mortality (p <0.01), reoperation (p <0.01), revision joint surgery (p = 0.02), and systemic complications (p <0.01) than NIDDM patients. The KSS-knee score was similar in IDDM and NIDDM patients, but the KSS-function score was lower in IDDM patients (p = 0.002). The overall survival rates of the prosthetic joints were similar between the groups. Among diabetic population who undergo THA and TKA, insulin dependence is a risk factor for postoperative complications, and inferior functional outcome but not for shorter survivorship of the prosthetic joints.