Do Patients With Diabetes Have Poorer Improvements in Patient-Reported Outcomes After Total Knee Arthroplasty?

Siyuan Zhang; Mark Chong; Bernard Puang Huh Lau; Yau Hong Ng; Xinyu Wang; Weiliang Chua

doi:10.1016/j.arth.2021.02.070

Do Patients With Diabetes Have Poorer Improvements in Patient-Reported Outcomes After Total Knee Arthroplasty?

J Arthroplasty. 2021 Jul;36(7):2486-2491. doi: 10.1016/j.arth.2021.02.070. Epub 2021 Mar 4.

Authors

Siyuan Zhang¹, Mark Chong², Bernard Puang Huh Lau², Yau Hong Ng², Xinyu Wang², Weiliang Chua²

Affiliations

¹ Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
² Department of Orthopaedic Surgery, National University Hospital, Singapore, Singapore.

PMID: 33775468
DOI: 10.1016/j.arth.2021.02.070

Abstract

Background: Diabetes is one of the most common comorbidities in patients undergoing total knee arthroplasty (TKA) for osteoarthritis. However, the evidence remains unclear on how it affects patient-reported outcome measures after TKA.

Methods: We reviewed prospectively collected data of 2840 patients who underwent primary unilateral TKA between 2008 and 2018, of which 716 (25.2%) had diabetes. All patients had their HbA1c measured within 1 month before surgery, and only well-controlled diabetics (HbA1c <8.0%) were allowed to proceed with surgery. Patient demographics and comorbidities were recorded, and multiple regression was performed to evaluate the impact of diabetes on improvements in patient-reported outcome measures (Short Form 36 (SF-36), Western Ontario and McMaster University Osteoarthritis Index (WOMAC), Knee Society Score (KSS)) and knee range of motion (ROM).

Results: Compared with nondiabetics, patients with diabetes were more likely to possess a higher body mass index (P-value <.001), more comorbidities (P-value <.001), and poorer preoperative SF-36 Physical Component Summary (PCS) (P-value <.001), WOMAC (P-value = .002), KSS-function (P-value <.001), and knee ROM (P-value <.001). Multiple regression showed that diabetic patients experienced marginally poorer improvements in KSS-knee (-1.22 points, P-value = .025) and knee ROM (-1.67°, P-value = .013) than nondiabetics. However, there were no significant differences in improvements for SF-36 PCS (P-value = .163), Mental Component Summary (P-value = .954), WOMAC (P-value = .815), and KSS-function (P-value = .866).

Conclusion: Patients with well-controlled diabetes (HbA1c <8.0%) can expect similar improvements in general health and osteoarthritis outcomes (SF-36 PCS and Mental Component Summary, WOMAC, and KSS-function) compared with nondiabetics after TKA. Despite having marginally poorer improvements in knee-specific outcomes (KSS-knee and knee ROM), these differences are unlikely to be clinically significant.

Keywords: diabetes; functional outcomes; patient-reported outcome measures; range of motion; total knee arthroplasty.

MeSH terms

Arthroplasty, Replacement, Knee*
Diabetes Mellitus* / epidemiology
Humans
Knee Joint / surgery
Knee Prosthesis*
Ontario
Osteoarthritis, Knee* / surgery
Patient Reported Outcome Measures
Range of Motion, Articular
Treatment Outcome