Clinical Practice (assessment, diagnosis, treatment, knowledge translation/EBP, implementation science, program development)
High prevalence of type 2 diabetes mellitus (T2DM) and substantial comorbidities were observed among patients undergoing primary total hip or total knee arthroplay (THA or TKA) for terminal osteorthritis (OA) even though HbA1c levels were less or equal to 7.0, which represents the standard of care. Such prevalence and risk for OA are higher among patients with T2DM, and worse among those T2DM patients who are on anti-diabetic medications compared to THA or TKA patients without T2DM. The risk for poor outcomes may be related to other T2DM factors beyond HbA1c and associated with either the pathophysiology advanced T2DM or anti-diabetic medications.
Objective: To characterize the clinical severity and comorbidities of type 2 diabetes mellitus (T2DM) and osteoarthritis (OA) clinical management progression
Design: Retrospective chart review from January 2008 to April 2013 using Current Procedure Terminology (CPT) codes for total hip arthroplasty (THA) and total knee arthroplasty (TKA).
Setting: Ambulatory and hospitalized care serving the greater Houston Area.
Participants (or Animals, Specimens, Cadavers): Consecutive sampling stratified by type 2 diabetes mellitus defined by ICD-10 codes, antidiabetic medication, and blood glucose levels. Patients with hip or knee arthroplasty due to fracture, post-traumatic arthritis, rheumatoid arthritis, developmental dysplasia of the hip, avascular necrosis, revision arthroplasty, hemiarthroplasty or incomplete medical records were excluded.to ensure arthroplasty was secondary to terminal OA. Patients who had bilateral or multiple arthroplasties during the designated timeframe were considered as individual subjects for each arthroplasty
Interventions: All participants received primary total knee arthroplasty. However, due to the observational nature of the study, no interventions were assessed.
Main Outcome Measure(s): Quantify the risk of having contralateral joint replacement or knee OA among those receiving a primary TKA stratified by T2DM status. Additionally, we examined omnibus comparisons to determine T2DM and non-DM group differences with one-way ANOVA for continuous and chi-square for nominal variables.
Results: A total of 137 patients received who received a THA, and 223 received a TKA, who also met the study inclusion and exclusion criteria. The prevalence of T2DM for THA was 19% (average age = 66.8 ± 9.8; mean BMI = 35.0 ± 6.5) and for TKA was 24.2%. Patients with T2DM were more likely to have additional comorbidities, be in more advanced in age at the time of surgery, be female and Hispanic. Patients with T2DM on anti-diabetic medication yielded an odds ratio of 4.2 times more likely to have contralateral OA or arthroplasty than their T2DM counterparts not on anti-diabetic medications.
Conclusions: High prevalence of T2DM and substantial comorbidities were observed among patients pursuing THA or TKA for terminal OA even though HbA1c levels were ≤ 7.0 – the standard of care. Such prevalence and risk for osteoarthritis are higher among patients with T2DM, and worse among those T2DM patients who are on anti-diabetic medications compared to THA or TKA patients without T2DM. The risk for poor outcomes may be related to other T2DM factors beyond HbA1c and associated with either the pathophysiology advanced T2DM or anti-diabetic medications.