Patients with diabetes who undergo either knee or hip replacement surgery are more likely to suffer complications than patients without diabetes. Those results were announced today at the 75th Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS). Further, patients with Type I diabetes are more likely to have complications than patients with Type II diabetes following the same surgery.

There are an estimated 20 million people in the United States with diabetes. Half are over the age of 60. In addition, half the people with diabetes have some form of arthritis. Hip and knee replacements are done largely to relieve arthritis pain, so it is important to understand that people with diabetes, especially Type I, have a longer and more costly hospital stay than other patients.

Complications in patients with Type I may be due to the differences in the two diabetes types. Diabetes occurs when the body does not regulate glucose (sugar) or produce insulin correctly. Type I diabetes patients are insulin dependent. Although, this form of the disease usually develops in children and young adults, onset can happen at any age. There are many risks and complications associated with Type I diabetes.

Type II diabetes effects more people. About 90 percent of those diagnosed with the disease are Type II and generally:
• older
• obese
• get little physical activity

Most people with Type II diabetes can control the disease with diet and exercise.

“Patients with Type I have to be rigidly managed in the hospital and are more complicated to treat,” said Michael P. Bolognesi, MD, author of the study presented today. Dr. Bolognesi is the director of adult reconstruction at Duke University Medical Center and an AAOS fellow. “Doctors will have to be more in tune with patients who have both Type I and Type II before and after surgery.”

This problem is expected to increase rapidly as more patients with both diabetes types require hip and knee replacement procedures. If doctors understand the risks to these patients who undergo hip and knee replacements, better post-surgery outcomes can be expected. For example, people with any type of diabetes, did better after surgery if they managed their disease well before the surgery.

“The study further supports that people with good control of their diabetes fare better than those whose disease is uncontrolled. Clearly, with those patients who have good control, there is a decrease in their complications and risks,” Dr. Bolognesi said.

Controlled patients with diabetes:
• see their primary care doctors regularly
• keep their blood sugar at the right level
• take their prescribed medication

Dr. Bolognesi stressed, “Doctors must continue to communicate their post-surgery concerns to patients with diabetes, then both doctor and patient will be more likely to be aware of warnings signs.”

Disclosure: Dr. Bolognesi received no compensation for this study.

Source: American Academy of Orthopaedic Surgeons (AAOS)