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Study finds diabetes does not increase risk of total knee surgical complications 2013

March 1, 2013

Patients with diabetes who undergo total knee replacement surgery do not have increased risk of surgical complications compared to those patients without diabetes, according to a Kaiser Permanente study published today in The Journal of Bone and Joint Surgery.

Researchers studied the electronic health records of more than 40,000 patients who had a first-time knee replacement from January 1, 2001 through December 31, 2009. Of the patients studied, 12.5 percent had controlled diabetes, 6.2 percent had uncontrolled diabetes and 81.3 percent did not have diabetes. In contrast to the findings of previous studies, researchers on this study found those with controlled and uncontrolled diabetes who underwent a total knee replacement were at no increased risk of complications such as follow-up surgery (also known as revision arthroplasty), deep infection, or blood clots in the legs or lungs, when compared to patients without diabetes.

"We are fortunate to do our research in a real-world setting that helps us to find real-world solutions for our patients," said Annette L. Adams, PhD, MPH, of the Kaiser Permanente Southern California Department of Research & Evaluation. "This current study suggests that patients with diabetes who have higher glucose levels may not be at greater risk of poor surgical outcomes. This finding will help physicians and their patients with diabetes make better informed decisions about total knee replacement as an option."

...The study also found that among the approximately 28 percent of patients who did experience adverse outcomes in the year after surgery, 27.1 percent were rehospitalized for any reason, 1.1 percent underwent follow-up surgery, 1 percent had a heart attack, 0.7 percent developed a deep infection while 0.5 percent had blood clots in the legs and lungs within the first 90 days after surgery..."

The study was conducted using the Kaiser Permanente Total Joint Replacement Registry, which now has more than 160,000 total joint arthroplasty procedures registered. Since its inception in 2001, Kaiser Permanente's registry has helped health care providers identify clinical best practices, evaluate and monitor patient outcomes and risk factors associated with revision surgeries, and assess the clinical effectiveness of implants.