This research reveals that diabetic patients are considerably more prone to serious postoperative issues, including infections, blood clots, and hospital readmissions. “This review clearly indicates that people with diabetes face higher chances of adverse outcomes after TKA, particularly those with insulin-treated diabetes,” Dr. Vaishya shared with Medical Dialogues. “Our findings highlight the need for thorough preoperative evaluation and better perioperative glycemic control in these patients.”
The study involved an extensive literature review from leading databases such as PubMed, Scopus, Web of Science, and the Cochrane Library, with the research protocol registered on PROSPERO in December 2024.
Key findings of the study include:
- A 43% increased risk of periprosthetic joint infections (PJI), a serious complication often requiring additional surgery and extended treatment.
- A 45% higher likelihood of developing deep vein thrombosis (DVT), which can lead to dangerous blood clots.
- A 28% rise in hospital readmission rates after TKA in people with diabetes.
- Individuals with insulin-dependent diabetes had a 60% greater incidence of perioperative complications, including cardiac events.
- The presence of poorly controlled blood sugar around the time of surgery emerged as a key modifiable risk factor, although the studies reviewed showed inconsistent definitions of optimal glycemic control.
According to Dr Anoop Misra, A co-author of the study, the elevated complication rates in people with diabetes can be attributed to several factors, including compromised immune function, vascular disease, and suboptimal glucose regulation. These issues increase vulnerability to infection, thrombosis, and other complications, ultimately impairing physical recovery and long-term joint function.
With diabetes affecting an increasing number of people globally—particularly in India and South Asia—the implications of this study are wide-reaching. Estimates suggest that up to half of all individuals undergoing knee replacement surgery may have diabetes, making this research highly relevant for both clinicians and health policy planners.
“These complications don’t just impact patient health—they also place additional strain on hospitals and healthcare systems,” Dr. Vaishya emphasized. “By improving blood sugar control before, during, and after surgery, we can potentially reduce these risks and improve recovery outcomes.”
The authors recommend that healthcare providers:
- Conduct comprehensive risk assessments before scheduling TKA for diabetic patients.
- Enforce stricter, yet personalized, blood sugar management protocols in the perioperative period.
- Ensure patients are fully informed about their elevated risks and the importance of maintaining good glycemic control.
"The study emphasizes the critical need for standardized care pathways and individualized management strategies for diabetic patients undergoing knee replacement surgery. As the diabetic population continues to grow, so too does the urgency of addressing these risks to enhance surgical outcomes and quality of life," the authors concluded.
Reference:
Vaishya R, Patralekh MK, Misra A, Vaish A. Outcomes of total knee arthroplasty in people with diabetes: An overview of systematic reviews and meta-analysis. J Orthop. 2025 Jul 1;65:336-345. doi: 10.1016/j.jor.2025.06.023. PMID: 40688449; PMCID: PMC12270691.
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