Diabetics undergoing total joint replacement often are at a higher risk of experiencing complications after surgery due to various pre-existing health conditions. According to a new study published in the July 2009 issue of The Journal of Bone and Joint Surgery (JBJS), those complications are less likely to occur when a diabetic patient has glucose levels under control.
"We found that controlled glucose levels really do make a difference for the patient," said study co-author Milford Marchant Jr., MD, an orthopaedic surgeon who conducted the study with colleagues of the Adult Reconstruction Section at Duke University Medical Center.
The study found that patients with uncontrolled glucose levels were:
- More than 3 times as likely to experience a stroke or death after joint replacement surgery; and
- About twice as likely to experience post-operative bleeding and infection.
Dr. Marchant and his colleagues reviewed data from a national healthcare database looking at more than one million patients who had total joint replacement surgery from 1988 to 2005. They compared surgical outcomes in patients with uncontrolled glucose levels to those who had controlled glucose levels and those patients who did not have diabetes.
"It did not matter if the patient had Type I or Type II diabetes," explains Dr. Marchant. "Regardless of diabetes type, we found that patients had fewer complications after surgery if their glucose level was controlled before, during and after surgery."
Diabetic patients with uncontrolled glucose were more likely to experience surgical complications, infection, blood transfusions and longer hospitals stays.
"The factors necessary for diabetic patients to be considered 'under control' are different for each individual patient, therefore diabetic patients should have good relationships with their medical doctors," said Dr. Marchant.
Study authors say that according to the American Diabetes Association, disease control is determined for each patient based on a series of laboratory blood tests and an assessment of diabetes-related illnesses. Approximately 8 percent of patients undergoing total hip and knee replacement in the United States have diabetes.
"It is crucial that patients have glucose levels well managed before, during and after surgery because it reduces the potential of having a complication," notes Dr. Marchant. "This is the responsibility of both the patient and the surgeon, and it should be a priority."
The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. Commercial entities (Zimmer and DePuy) paid or directed in any one year, or agreed to pay or direct, benefits in excess of $10,000 to a research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which one or more of the authors, or a member of his or her immediate family, is affiliated or associated.
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