Results of knee joint replacement in patients with diabetes mellitus type 2

Ivanov Leonid V., Guryev Vladimir V., Ярыгин Николай Владимирович

A comparative assessment of knee joint alloplasty (KJA) results in patients with gonarthrosis with and without concomitant pathology of type 2 diabetes mellitus (DM 2) has been carried out. The data of 104 patients were analyzed. They are treated on the basis of the Center for Traumatology and Orthopedics at the Semashko Russian Railways Hospital in the years 2003-2017 prosthetics of the knee joints were performed (mean age 65.2 ± 10.5 years, mean observation period - 7.8 years, from 4 to 14 years). Primary total knee arthroplasty was performed with cement prostheses manufactured by Biomet (Aigisi, Avangard) and Eskulap. Patients were included in 2 groups: group 1 - 56 patients without signs of DM, group 2 - 48 patients with DM. Comparison of the characteristics of patients without diabetes and with DM 2 who underwent KJA showed that there were no significant differences in the incidence of intraoperative complications, patients with DM 2 had slightly longer inpatient treatment and frequency of postoperative complications. Analysis of the clinical and functional state using the Knee Society Score indicated that in patients without diabetes the dynamics of improvement in the functional status of the knee joint was slightly more pronounced, after 1 year there were statistically significant differences in terms of this scale. Evaluation of long-term complications over a long observation period showed that the absolute majority of patients in both groups of complications were not observed, however, in the group of patients with diabetes, the proportion of patients without complications is slightly lower than among patients without DM, respectively 25.0 and 5 four %. It was concluded that during the decision-making process on the arthroplasty, surgical risk should be assessed for patients with diabetes, taking into account possible complications and the presence of other associated diseases. One of the main goals of the preoperative preparation of the considered patient category should be the stabilization of the blood plasma glucose level.

Keywords:joint replacement, diabetes mellitus, insulin, hip joint, knee joint, glycemic control