Authors (including presenting author) :
Lau LCM(1), Tsoi KH(2), Xiong X(3), Tan KCB(2), Chan LPK(1), Fu H(1), Lui DTW(2)
Affiliation :
(1)Department of Orthopaedics and Traumatology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, (2)Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, (3)Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong
Introduction :
With the implementation of a program aiming for optimized preoperative glycemic control, we evaluated the clinical outcomes and their predictors among patients with type 2 diabetes who had achieved satisfactory glycemic control before total knee replacement (TKR).
Objectives :
In this study, we (i) examined the functional outcomes, postoperative complications and survival of patients with type 2 diabetes who underwent TKR during the implementation of a preoperative diabetes optimization program and (ii) identified their independent predictors.
Methodology :
We included patients with type 2 diabetes who underwent TKR during implementation of the preoperative glycemic optimization program (2016–2021). Diabetes-specific factors, knee and function scores, postoperative complications and mortality were retrieved. Multivariable regression analyses were performed to identify independent predictors of postoperative outcomes.
Result & Outcome :
382 knees (in 294 patients) were included: mean age 72.1±8.5years, 34.8% men, body mass index 28.5±4.6kg/m2, duration of diabetes 10.1±8.6years. Pre-operative glycated hemoglobin (HbA1c) was 6.6±0.6%, and 95.5% achieved HbA1c≤7.5%. Rates of periprosthetic joint infection and all-cause revision were only 1.6% and 2.4% respectively. Coronary artery disease (CAD) independently predicted lower likelihood of satisfactory one-year knee score (adjusted OR [aOR] for knee score≥90 =0.48, p=0.026). Older age (≥65years)(aOR=0.40,p=0.002), long duration of diabetes (≥10years)(aOR=0.54, p=0.008) and diabetic retinopathy (aOR=0.54, p=0.049) all independently predicted lower likelihood of achieving satisfactory one-year function score (≥56). Long duration of diabetes (adjusted HR [aHR]=2.50,p< 0.001) and CAD (aHR=2.10,p=0.018) independently predicted all-cause mortality. Glycemic control was no longer a significant predictor of all the above outcomes.
In conclusion, standard program could optimize preoperative glycemic control among type 2 diabetes before TKR. More intensive glycemic control might not be associated with further improvement in outcomes. Residual postoperative risks were characterized by features of diabetes chronicity, namely, duration of diabetes and presence of complications.
