Diabetes No Impediment to Successful TKA

There is one less thing for patients and their doctors to worry about: patients with diabetes who undergo total knee replacement (TKA) surgery do not have an increased risk of surgical complications when compared to patients without diabetes. That is the welcome conclusion of a Kaiser Permanente study recently published 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 between January 1, 2001 and December 31, 2009. Twelve and a half percent of the patients studied had controlled diabetes, 6.2% had uncontrolled diabetes and 81.3% did not have diabetes The researchers found that those patients who had either controlled or uncontrolled diabetes who underwent a total knee replacement were at no increased risk of complications such as follow-up surgery, deep infection, or blood clots in the legs or lungs, when they were 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, Ph.D., M.P.H., 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.”

One reason this study differed from previous research on the topic was that the Kaiser Permanente patients with diabetes had better glycemic control than previous study populations, said Adams. “We have good quality of care, and good chronic disease management and in this setting glycemic control had little impact on the outcome of total knee replacement surgery.”

“While this study puts us one step closer to understanding diabetes-related complications associated with surgical procedures, more research is needed to determine what aspects of diabetes are associated with adverse outcomes, ” said Robert Namba, M.D., Department of Orthopedic Surgery at Kaiser Permanente Southern California. “It is important to note that patients with diabetes remain at high risk of a number of poor health outcomes affecting many organ systems and clinicians should continue to review all available information about the overall health and stability of these vulnerable patients.”

Kaiser Permanente’s Center for Effectiveness and Safety Research sponsored the study. The Center facilitates inter-regional research conducted by the research programs in each of Kaiser Permanente’s eight regions (Colorado, Georgia, Hawaii, Mid-Atlantic States, Northern California, Northwest, Ohio, and Southern California).