Abstract
Background Diabetes mellitus (DM) is a common disease that has an adverse impact on most orthopedic surgeries, and its prevalence has gradually increased in recent years. We aim to investigate the influence of DM on comorbidities and complications of patients undergoing primary total lower extremity arthroplasty. Methods PubMed, Embase, Cochrane Library, Medline, and Web of Science were systematically searched for relevant studies published before December 2019. Demographic data, comorbidities, and postoperative complications after primary total hip arthroplasties (THA) or primary total knee arthroplasties (TKA) were assessed between DM and non-DM patients. Meta-analysis was conducted using Review Manager 5.3, and forest plots were drawn for each variable. Results A total of 1,560,461 patients (215,916 patients with DM and 1,344,545 patients without DM) from 23 studies were included in this meta-analysis. The incidences of several preoperative comorbidities (hypertension (HTN), kidney disease, cardiac and cerebrovascular disease) were generally higher in patients with DM. Moreover, DM patients had a higher rate of postoperative complications (superficial and deep infection, deep vein thrombosis (DVT), and in-hospital mortality) compared to non-DM patients. Conclusions DM patients were more likely to suffer from comorbidities and had a higher risk of complications in total lower extremity arthroplasty compared to non-DM patients. It is necessary to identify DM and control hyperglycemia in the perioperative period to prevent postoperative complications in patients with DM.
Highlights
Elective primary total lower extremity arthroplasty, which mainly refers to total knee and hip joint arthroplasty (TKA and total hip arthroplasties (THA)), is a major operation frequently performed for knee and hip disease patients to reduce joint pain and increase joint mobility and function [1]
The fixed-effect model found that Diabetes mellitus (DM) patients had significantly higher morbidity of HTN (OR = 4:26, 95% confidence intervals (CI): 3.97, 4.57, p < 0:00001, I2 = 87%)
Two studies [32, 34] and six studies [14, 18, 24, 32,33,34] reported the rate of cerebrovascular disease and cardiac disease, respectively, and the fixed-effect model indicated that DM significantly increased the risk of suffering from cerebral disease (OR = 1:93, 95% CI: 1.84, 2.03, p < 0:00001, I2 = 0%) (Figure 2(b)) and cardiac disease (OR = 2:50, 95% CI: 2.43, 2.58, p < 0:00001, I2 = 7%) (Figure 2(c))
Summary
Elective primary total lower extremity arthroplasty, which mainly refers to total knee and hip joint arthroplasty (TKA and THA), is a major operation frequently performed for knee and hip disease patients to reduce joint pain and increase joint mobility and function [1]. TKA and THA patients with certain preexisting diseases are at increased risk of postoperative complications. Several studies have investigated the impact of DM on the postoperative prognosis for patients undergoing TKA and THA and have indicated that DM patients have an increased rate of infection, vascular disease, and myocardial infarction compared with non-DM patients [6,7,8]. Demographic data, comorbidities, and postoperative complications after primary total hip arthroplasties (THA) or primary total knee arthroplasties (TKA) were assessed between DM and non-DM patients. DM patients had a higher rate of postoperative complications (superficial and deep infection, deep vein thrombosis (DVT), and in-hospital mortality) compared to non-DM patients. DM patients were more likely to suffer from comorbidities and had a higher risk of complications in total lower extremity arthroplasty compared to non-DM patients.
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