Total Hip Arthroplasty in Patients with Diabetes Mellitus

Suh, Kuen Tak; Lee, Hong Seok; Kim, Myoung Soo; Lee, Jung Sub; Kim, Jeung-Il

doi:10.4055/jkoa.2009.44.5.526

J Korean Orthop Assoc. 2009 Oct;44(5):526-532. Korean.
Published online Sep 23, 2009.
https://doi.org/10.4055/jkoa.2009.44.5.526

Original Article

Total Hip Arthroplasty in Patients with Diabetes Mellitus

Kuen Tak Suh, M.D., Hong Seok Lee, M.D., Myoung Soo Kim, M.D., Jung Sub Lee, M.D. and Jeung-Il Kim, M.D.

Author information

Author notes

Copyright and License

- Department of Orthopedic Surgery, Pusan National University School of Medicine, Busan, Korea.
Correspondence to Kuen Tak Suh, M.D. Department of Orthopaedic Surgery, Pusan National University Yangsan Hospital, Beomeo-ri, Mulgeum-eup, Yangsan 626-770, Korea. Tel: +82.51-510-8000, Fax: +82.51-510-8026, Email: kuentak@pusan.ac.kr

Received February 19, 2009; Accepted June 22, 2009.

Abstract

Purpose

The purpose of present study is to analyze the incidence and the predisposing factors for postoperative complications that diabetes mellitus (DM) patients suffer after undergoing total hip arthroplasty.

Materials and Methods

Among the 379 patients who underwent primary cementless total hip arthroplasty from September 1998 to February 2007, fifty-nine patients (62 hips) who had DM were selected and the other 320 patients (378 hips) without DM were set as a control group to perform comparative analysis. The mean follow up period was 36 months (range, 12-117 months) and the mean age of patients was 55.5 years (range, 16-79 years). The preoperative and annual postoperative Harris Hip Score (HHS) and the postoperative complications were checked. We analyzed the factors that were associated with the incidence of postoperative complications in DM patients.

Results

The DM group had a higher incidence of urinary tract infection and a longer admission period than did non-DM group (p=0.001 and p=0.002). The HHS was 52 and 53 (p=0.185), respectively, for the DM patients and the non-DM patients preoperatively, and it was 93 and 95 (p=0.467), respectively, at the last follow up. The predisposing factors for postoperative complications in DM patients are a high hemoglobin A1c (HbA1c) level and comorbidities.

Conclusion

Total hip arthroplasty in DM patients is associated with a higher incidence of postoperative complications and a prolonged admission period. A high HbA1c level and comorbidities are considered to have significant associations with these complications.

Keywords

Diabetes mellitus; Total hip arthroplasty; Complications

Tables

Table 1
Comparison of the Patients with and without Diabetes Mellitus

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Table 2
The Characteristics of the Patients with Diabetes Mellitus

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Table 3
Average Clinical Score

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Table 4
Complications Comparing Individuals with and without Diabetes Mellitus

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Table 5
Statistical Analysis of the Relationships between Preoperative Factors and Postoperative Complications in Diabetes Mellitus Group

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References

1. Centers for Disease Control: National Diabetes Fact Sheet. Division of Diabetes Translation: National Center for Chronic Disease Prevention and Health Promotion. Atlanta: Centers for Disease Control and Prevention; 2002.
1. The committee on the epidemiology of diabetes mellitus. Korean Diabetes Association. The epidemiology of diabetes mellitus in Korea. 2005.
1. Fitzgerald RH Jr, Nolan DR, Ilstrup DM, Van Scoy RE, Washington JA 2nd, Coventry MB. Deep wound sepsis following total hip arthroplasty. . J Bone Joint Surg Am 1977;59:847–855.
  PubMed
1. Glynn MK, Sheehan JM. The significance of asymptomatic bacteriuria in patients undergoing hip/knee arthroplasty. Clin Orthop Relat Res 1984;185:151–154.
  PubMed
1. Goodson WH 3rd, Hung TK. Studies of wound healing in experimental diabetes mellitus. J Surg Res 1977;22:221–227.
  PubMed
  
  CrossRef
1. Joshi N, Caputo GM, Weitekamp MR, Karchmer AW. Infections in patients with diabetes mellitus. N Engl J Med 1999;341:1906–1912.
  PubMed
  
  CrossRef
1. Bolognesi MP, Marchant MH Jr, Viens NA, Cook C, Pietrobon R, Vail TP. The impact of diabetes on perioperative patient outcomes after total hip and total knee arthroplasty in the United States. J Arthroplasty 2008;23 Suppl:92–98.
  CrossRef
1. Moeckel B, Huo MH, Salvati EA, Pellicci PM. Total hip arthroplasty in patients with diabetes mellitus. J Arthroplasty 1993;8:279–284.
  PubMed
  
  CrossRef
1. Vannini P, Ciavarella A, Olmi R, et al. Diabetes as pro-infective risk factor in total hip replacement. Acta Diabetol Lat 1984;21:275–280.
  PubMed
  
  CrossRef
1. Kurzweil PR. Antibiotic prophylaxis for arthroscopic surgery. Arthroscopy 2006;22:452–454.
  PubMed
  
  CrossRef
1. Jahoda D, Nyc O, Pokorný D, Landor I, Sosna A. Antibiotic treatment for prevention of infectious complications in joint replacement. Acta Chir Orthop Traumatol Cech 2006;73:108–114.
  PubMed
1. Loder RT. The influence of diabetes mellitus on the healing of closed fractures. Clin Orthop Relat Res 1988;232:210–216.
  PubMed
1. Menon TJ, Thjellesen D, Wroblewski BM. Charnley low-friction arthroplasty in diabetic patients. J Bone Joint Surg Br 1983;65:580–581.
  PubMed
1. Michelson JD, Lotke PA, Steinberg ME. Urinary-bladder management after total joint-replacement surgery. N Engl J Med 1988;319:321–326.
  PubMed
  
  CrossRef
1. England SP, Stern SH, Insall JN, Windsor RE. Total knee arthroplasty in diabetes mellitus. Clin Orthop Relat Res 1990;260:130–134.
  PubMed
1. Sutherland CJ, Schurman JR. Complications associated with warfarin prophylaxis in total knee arthroplasty. Clin Orthop Relat Res 1987;219:158–162.
  PubMed
1. Drennan DB, Fahey JJ, Maylahn DJ. Important factors in achieving arthrodesis of the Charcot knee. J Bone Joint Surg Am 1971;53:1180–1193.
  PubMed
1. Einhorn TA, Boskey AL, Gundberg CM, Vigorita VJ, Devliu VJ, Beyer MM. The mineral and mechanical properties of bone in chronic experimental diabetes. J Orthop Res 1988;6:317–323.
  PubMed
  
  CrossRef
1. Alvin CP. Diabetes mellitus. In: Dennis LK, Eugene B, Anthony SF, et al., editors. Harrison's principles of internal medicine. 16th ed. New York: McGraw-Hill; 2004. pp. 2152-2180.
1. O'sullivan CJ, Hynes N, Mahendran B, et al. Haemoglobin A1c (HbA1C) in non-diabetic and diabetic vascular patient. Is HbA1C an independent risk factor and predictor of adverse outcome? Eur J Vasc Endovasc Surg 2006;32:188–197.