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Inadequate pre-operative glycaemic control in patients with diabetes mellitus adversely influences functional recovery after total knee arthroplasty: Patients with impaired glycaemic control exhibit poorer functional outcomes at 1-year post-arthroplasty

Lookup NU author(s): Timothy Brock, Dr Mark Shirley, Michelle Bardgett, Professor Mark Walker, Professor David Deehan

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Abstract

© 2016 European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) Purpose: Whilst inadequate glycaemic control is associated with an increase in perioperative complications following total knee arthroplasty, the impact of glycaemic control in this at-risk patient group remains ill-defined. Identification of at-risk patients would allow targeted pre-operative glycaemic control intervention. Methods: One hundred consecutive patients with a diagnosis of diabetes mellitus and one hundred age, sex and BMI matched patients without diabetes undergoing total knee arthroplasty in a single institution were analysed between 2008 and 2013. Inadequate glycaemic control was defined as having an HbA1c of greater than 64 mmol/mol (8.0 % NGSP) measured within the 3 months before surgery. Patient demographics, diabetes management and complications of diabetes were recorded and used as explanatory variables to deliver a generalised linear model. This allows for relationships to be defined between change in patient-reported function (SF-36, WOMAC) and these explanatory variables. Results: The patient group with concomitant diabetes exhibited smaller improvements in WOMAC and SF-36 physical component summary at 1 year after knee arthroplasty. This effect was most pronounced in the subset of patients with inadequate glycaemic control recorded in the early pre-operative period. Conclusion: Patients with diabetes, particularly those with inadequate glycaemic control, exhibit less improvement at 1 year following knee arthroplasty than patients without diabetes mellitus. Clinical focus on modulating this factor in this at-risk group is warranted. Level of evidence: III.


Publication metadata

Author(s): Brock TM, Shirley M, Bardgett M, Walker M, Deehan DJ

Publication type: Article

Publication status: Published

Journal: Knee Surgery, Sports Traumatology, Arthroscopy

Year: 2017

Volume: 25

Issue: 6

Pages: 1801-1806

Print publication date: 01/06/2017

Online publication date: 08/08/2016

Acceptance date: 27/07/2016

ISSN (print): 0942-2056

ISSN (electronic): 1433-7347

Publisher: Springer Verlag

URL: https://doi.org/10.1007/s00167-016-4249-0

DOI: 10.1007/s00167-016-4249-0


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