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Diabetes and the Heightened Risk of Periprosthetic Joint Infection

Diabetes woman ready for morning run along the coastDr. Stickney, a Kirkland orthopedic surgeon, is an expert in joint replacementsports medicine, and more.

Diabetes is prevalent not just in the U.S., it affects millions of people worldwide and is one of the leading causes of disability. Its direct effects on postoperative care can impact both the patient and an already strained healthcare system. In the world of orthopedic surgery specifically, little has been documented about a diabetic patient’s incidence of infection after undergoing total knee or total hip arthroplasty.

A recent investigation by researchers at the University of Utah looked at data of type-1 and type-2 diabetes mellitus patients and the incidence of periprosthetic joint infection. By looking at historical, statewide data of more than 75,000 patients undergoing knee or hip arthroplasty between 1996 and 2013, researchers were able to identify 1,668 patients with type-1 diabetes and another 18,186 patients with type-2 diabetes, providing a strong sample size. The researchers hypothesized that arthroplasty patients with type-1 diabetes were at greater risk for infection than those with type-2 diabetes.

While age and sex were found to be insignificant factors contributing to infection rates, the study did find that the frequency of periprosthetic joint infection in non-diabetic patients was 2.6% compared with 4.3% infection rates across all diabetic patients. Looking more specifically at the differences in infection rates between the two types of diabetes, patients with type-1 diabetes were at a 1.8 times greater rate of infection than patients with type-2 diabetes (7% compared to 4%, respectively).

Diabetes-related complications indicated a greater risk of periprosthetic joint infection; these include peripheral circulatory disorders, ketoacidosis, neurological manifestations, renal manifestations, or ophthalmic manifestations, hyperosmolarity (common in type-2 diabetes, where the body tries to rid itself of excess blood sugar via urination), and coma. The odds of infection increased with each added complication, and diabetes patients with more than four of these complications put them at nine times more risk. Weight also plays a role; overweight and obese type-2 diabetes patients, as well as underweight type-1 diabetes patients were also at greater risk for periprosthetic joint infection when compared with the general population.

Findings suggest it may be important to look at the length of time patients have had diabetes, factor in a patient’s diabetes type, and understand a patient’s number of diabetes-related complications prior to any joint replacement surgery. This information can help patients to make a more informed decision and help healthcare providers better manage risk.

If you have chronic health conditions and would like to learn more about how to avoid post-surgical complications related to TKA or THA, please contact our office. We’ll help you return to your healthy, pain-free lifestyle.