Perioperative Complications and Impact of Diabetes Mellitus Severity on Revision Total Knee Arthroplasty

Background: Total knee arthroplasty (TKA) is a common and effective treatment of knee osteoarthritis. As the amount of TKAs performed increases, so does the number of TKA failures and subsequent revisions. Diabetes mellitus (DM) has been shown to increase complications following orthopedic procedures. For these reasons, it is important to understand the association between severity of DM and the risk of perioperative adverse events following revision TKA. Methods: A retrospective cohort study was conducted using the American College of Surgeons National Surgical Quality Improvement Program database. Patients who underwent revision TKAs between 2007 and 2014 were identified and recorded as having non-insulin-dependent DM (NIDDM), insulin-dependent DM (IDDM), or no DM. Univariate and multivariate analysis were used to evaluate the incidence of multiple adverse events within 30 days after revision TKA. Results: A total of 9,921 patients who underwent revision TKA were selected (without DM = 7845 [79.1%]; NIDDM = 1349 [13.6%]; IDDM = 727 [7.3%]). Patients with NIDDM were found to have an increased risk of developing 1 of 20 adverse events studied compared to patients without DM, while patients with IDDM were found to have an increased risk of developing 6 of 20 adverse events compared to patients without DM. Conclusion: Relative to patients with NIDDM, those with IDDM have a greater likelihood of developing more adverse perioperative outcomes than patients without DM. Although complication rates remain relatively low, orthopedic surgeons must consider the implications of diabetes and insulin dependence on patient selection, preoperative risk stratification, and postoperative outcomes