The outcome of total hip arthroplasty in diabetes mellitus

Abstract

n analysis on prospective data on our hip database was carried out on all patients undergoing primary cemented unilateral total hip arthroplasty. There were 1,220 non-diabetic and 77 diabetic patients identified with at least three years follow-up. We found no significant difference with respect to age, sex and diagnosis between the two groups. Diabetic patients did have a significantly higher body mass index (BMI) and higher incidence of coronary artery disease. We found no increase in the rate of deep periprosthetic infection, superficial wound complications, dislocation, blood loss and deep vein thrombosis (DVT) between patients with and without diabetes even after adjusting for potential confounders. Diabetic patients had a longer length of stay (10.73 versus 9.56 days, p<0.05). Further analysis of the diabetic group showed no difference, with the same outcomes in patients between insulin-dependent and non-insulin dependent diabetic subsets. From this study we conclude that at the time of taking informed consent from patients undergoing total hip arthroplasty the only potential difference between those with and without diabetes is that the length of stay may be longer for patients with diabetes. Br J Diabetes Vasc Dis 2005;5:146—9

Keywords

hip arthroplasty diabetes infection outcome.

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References

Report by the controller and auditor general. Hip replacements: an update, July 2003. HC956; Session 2002-2003.

Dixon T. , Shaw M. , Ebrahim S. et al. Trends in hip and knee joint replacement: socioeconomic inequalities and projections of need. Ann Rheum Dis 2004 ;63:825-30.

Madey SM , Callaghan JJ , Olejniczak JP , Goetz DD , Johnston RC Charnley total hip arthroplasty with use of improved technique of cementing: the results after a minimum of 15 years follow up. J Bone Joint Surg Am 1997;79:53-64.

Alsema R. , Deutman R. , Mulder TJ Stanmore total hip arthroplasty: a 15 to 16-year clinical and radiographic follow up. J Bone Joint Surg Br 1994; 78:240-4.

International Diabetes Federation 2004. Facts and figures; prevalence www.idf.org/home/index.cfm?node=264

Diabetes UK. Fact sheet; no 2. 2004. www.diabetes.org.uk/fact/fact2.htm

Menon TJ , Thjellesen D. , Wroblewski BM Charnley low friction arthroplasty in diabetic patients. J Bone Joint Surg Br 1983;65:580-1.

Moeckel B. , Huo MH , Salvati EA , Pellicci PM Total hip arthroplasty in patients with diabetes mellitus. J Arthroplasty 1993;8:279-84.

Pagagelopoulos J. , Osaretin B. , Wallrichs L. et al. Long term outcome and survivorship analysis of primary total knee arthroplasty in patients with diabetes mellitus . Clin Orthop 1996;330:124-32.

10.

England SP , Stern SH , Insall JN et al. Total knee arthroplasty in diabetes mellitus. Clin Orthop 1990;260:130-4.

11.

Yang K. , Yeo SJ , Lee BP , Lo NN Total knee arthroplasty in diabetic patients: a study of 109 consecutive cases . J Arthroplasty 2001;16:10206.

12.

Serna F. , Mont MA , Krackow KA , Hungerford DS Total knee arthroplasty in diabetic patients; comparison to a matched control . J Arthroplasty 1994;9:375-9.

13.

Hanssen AD , Osmon DR , Nelson CL Prevention of deep periprosthetic joint infection. Instr Course Lect 1997;46:555-67.

14.

Yong KS , Kareem BA , Ruslan GN , Harwant S. Risk factors for infection in total hip replacement surgery at Hospital Kuala Lumpur. Med J Malaysia 2001;56(suppl C):57-60.

15.

Schutzer SF , Harris WH Deep wound infection after total hip replacement under contemporary aseptic conditions. J Bone Joint Surg Am 1998;70:724-7.

16.

Schmalzried TP , Amstutz HC , Au MK , Dorey FJ Etiology of deep sepsis in total hip arthroplasty. The significance of haematogenous and recurrent infections. Clin Orthop Relat Res 1992;280:200-07.

17.

Maderazo EJ , Judson S. , Pasternak H. Late infections of total joint prosthesis; A review and recommendations for prevention. Clin Orthop 1988; 229:131-42.

18.

Smith SE , Harris WH Total hip arthroplasty performed with insertion of the femoral component with cement and the acetabular component without cement. Ten to thirteen-year results . J Bone Joint Surg Am 1997; 79:1827-33.

19.

Colwell CW Jr , Collis DK , Paulson R. et al. Comparison of enoxaparin and warfarin for the prevention of venous thromboembolic disease after total hip arthroplasty; Evaluation during hospitalization and three months after discharge. J Bone Joint Surg Am 1999;81:932-40.

20.

Bourne RB , Mehin R. The dislocating hip. What to do, what to do. J Arthroplasty 2004;19:111-14.