Inadequate pre-operative glycaemic control in patients with diabetes mellitus adversely influences functional recovery after total knee arthroplasty: Patients with impaired glycaemic control exhibit poorer functional outcomes at 1-year post-arthroplasty

Purpose Whilst inadequate glycaemic control is associated with an increase in perioperative complications following total knee arthroplasty, the impact of glycaemic control in this at-risk patient group remains ill-defined. Identification of at-risk patients would allow targeted pre-operative glycae...

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Veröffentlicht in:Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA sports traumatology, arthroscopy : official journal of the ESSKA, 2017-06, Vol.25 (6), p.1801-1806
Hauptverfasser: Brock, Timothy M., Shirley, Mark, Bardgett, Michelle, Walker, Mark, Deehan, David J.
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container_end_page 1806
container_issue 6
container_start_page 1801
container_title Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA
container_volume 25
creator Brock, Timothy M.
Shirley, Mark
Bardgett, Michelle
Walker, Mark
Deehan, David J.
description Purpose Whilst inadequate glycaemic control is associated with an increase in perioperative complications following total knee arthroplasty, the impact of glycaemic control in this at-risk patient group remains ill-defined. Identification of at-risk patients would allow targeted pre-operative glycaemic control intervention. Methods One hundred consecutive patients with a diagnosis of diabetes mellitus and one hundred age, sex and BMI matched patients without diabetes undergoing total knee arthroplasty in a single institution were analysed between 2008 and 2013. Inadequate glycaemic control was defined as having an HbA1c of greater than 64 mmol/mol (8.0 % NGSP) measured within the 3 months before surgery. Patient demographics, diabetes management and complications of diabetes were recorded and used as explanatory variables to deliver a generalised linear model. This allows for relationships to be defined between change in patient-reported function (SF-36, WOMAC) and these explanatory variables. Results The patient group with concomitant diabetes exhibited smaller improvements in WOMAC and SF-36 physical component summary at 1 year after knee arthroplasty. This effect was most pronounced in the subset of patients with inadequate glycaemic control recorded in the early pre-operative period. Conclusion Patients with diabetes, particularly those with inadequate glycaemic control, exhibit less improvement at 1 year following knee arthroplasty than patients without diabetes mellitus. Clinical focus on modulating this factor in this at-risk group is warranted. Level of evidence III.
doi_str_mv 10.1007/s00167-016-4249-0
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Identification of at-risk patients would allow targeted pre-operative glycaemic control intervention. Methods One hundred consecutive patients with a diagnosis of diabetes mellitus and one hundred age, sex and BMI matched patients without diabetes undergoing total knee arthroplasty in a single institution were analysed between 2008 and 2013. Inadequate glycaemic control was defined as having an HbA1c of greater than 64 mmol/mol (8.0 % NGSP) measured within the 3 months before surgery. Patient demographics, diabetes management and complications of diabetes were recorded and used as explanatory variables to deliver a generalised linear model. This allows for relationships to be defined between change in patient-reported function (SF-36, WOMAC) and these explanatory variables. Results The patient group with concomitant diabetes exhibited smaller improvements in WOMAC and SF-36 physical component summary at 1 year after knee arthroplasty. This effect was most pronounced in the subset of patients with inadequate glycaemic control recorded in the early pre-operative period. Conclusion Patients with diabetes, particularly those with inadequate glycaemic control, exhibit less improvement at 1 year following knee arthroplasty than patients without diabetes mellitus. Clinical focus on modulating this factor in this at-risk group is warranted. Level of evidence III.</description><identifier>ISSN: 0942-2056</identifier><identifier>EISSN: 1433-7347</identifier><identifier>DOI: 10.1007/s00167-016-4249-0</identifier><identifier>PMID: 27502788</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Aged ; Aged, 80 and over ; Arthroplasty (knee) ; Arthroplasty, Replacement, Knee - adverse effects ; Biomedical materials ; Blood Glucose - metabolism ; Body mass ; Complications ; Demographics ; Demography ; Diabetes ; Diabetes Complications ; Diabetes mellitus ; Diabetes Mellitus - blood ; Female ; Glycated Hemoglobin A - analysis ; Group therapy ; Humans ; Intervention ; Joint surgery ; Knee ; Male ; Medicine ; Medicine &amp; Public Health ; Middle Aged ; Orthopedics ; Patients ; Postoperative Complications ; Recovery (Medical) ; Recovery of Function ; Retrospective Studies ; Risk factors ; Risk management ; Surgery ; Surgical implants</subject><ispartof>Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2017-06, Vol.25 (6), p.1801-1806</ispartof><rights>European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2016</rights><rights>Knee Surgery, Sports Traumatology, Arthroscopy is a copyright of Springer, 2017.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c2390-9d5edf90c02db1a8f0d50f247ebdb9a3e62701b8c83530e55afbdabab580bda43</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00167-016-4249-0$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00167-016-4249-0$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>315,781,785,27926,27927,41490,42559,51321</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27502788$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Brock, Timothy M.</creatorcontrib><creatorcontrib>Shirley, Mark</creatorcontrib><creatorcontrib>Bardgett, Michelle</creatorcontrib><creatorcontrib>Walker, Mark</creatorcontrib><creatorcontrib>Deehan, David J.</creatorcontrib><title>Inadequate pre-operative glycaemic control in patients with diabetes mellitus adversely influences functional recovery after total knee arthroplasty: Patients with impaired glycaemic control exhibit poorer functional outcomes at 1-year post-arthroplasty</title><title>Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA</title><addtitle>Knee Surg Sports Traumatol Arthrosc</addtitle><addtitle>Knee Surg Sports Traumatol Arthrosc</addtitle><description>Purpose Whilst inadequate glycaemic control is associated with an increase in perioperative complications following total knee arthroplasty, the impact of glycaemic control in this at-risk patient group remains ill-defined. Identification of at-risk patients would allow targeted pre-operative glycaemic control intervention. Methods One hundred consecutive patients with a diagnosis of diabetes mellitus and one hundred age, sex and BMI matched patients without diabetes undergoing total knee arthroplasty in a single institution were analysed between 2008 and 2013. Inadequate glycaemic control was defined as having an HbA1c of greater than 64 mmol/mol (8.0 % NGSP) measured within the 3 months before surgery. Patient demographics, diabetes management and complications of diabetes were recorded and used as explanatory variables to deliver a generalised linear model. This allows for relationships to be defined between change in patient-reported function (SF-36, WOMAC) and these explanatory variables. Results The patient group with concomitant diabetes exhibited smaller improvements in WOMAC and SF-36 physical component summary at 1 year after knee arthroplasty. This effect was most pronounced in the subset of patients with inadequate glycaemic control recorded in the early pre-operative period. Conclusion Patients with diabetes, particularly those with inadequate glycaemic control, exhibit less improvement at 1 year following knee arthroplasty than patients without diabetes mellitus. Clinical focus on modulating this factor in this at-risk group is warranted. 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Identification of at-risk patients would allow targeted pre-operative glycaemic control intervention. Methods One hundred consecutive patients with a diagnosis of diabetes mellitus and one hundred age, sex and BMI matched patients without diabetes undergoing total knee arthroplasty in a single institution were analysed between 2008 and 2013. Inadequate glycaemic control was defined as having an HbA1c of greater than 64 mmol/mol (8.0 % NGSP) measured within the 3 months before surgery. Patient demographics, diabetes management and complications of diabetes were recorded and used as explanatory variables to deliver a generalised linear model. This allows for relationships to be defined between change in patient-reported function (SF-36, WOMAC) and these explanatory variables. Results The patient group with concomitant diabetes exhibited smaller improvements in WOMAC and SF-36 physical component summary at 1 year after knee arthroplasty. This effect was most pronounced in the subset of patients with inadequate glycaemic control recorded in the early pre-operative period. Conclusion Patients with diabetes, particularly those with inadequate glycaemic control, exhibit less improvement at 1 year following knee arthroplasty than patients without diabetes mellitus. Clinical focus on modulating this factor in this at-risk group is warranted. Level of evidence III.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>27502788</pmid><doi>10.1007/s00167-016-4249-0</doi><tpages>6</tpages></addata></record>
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source MEDLINE; SpringerNature Journals; Access via Wiley Online Library
subjects Aged
Aged, 80 and over
Arthroplasty (knee)
Arthroplasty, Replacement, Knee - adverse effects
Biomedical materials
Blood Glucose - metabolism
Body mass
Complications
Demographics
Demography
Diabetes
Diabetes Complications
Diabetes mellitus
Diabetes Mellitus - blood
Female
Glycated Hemoglobin A - analysis
Group therapy
Humans
Intervention
Joint surgery
Knee
Male
Medicine
Medicine & Public Health
Middle Aged
Orthopedics
Patients
Postoperative Complications
Recovery (Medical)
Recovery of Function
Retrospective Studies
Risk factors
Risk management
Surgery
Surgical implants
title Inadequate pre-operative glycaemic control in patients with diabetes mellitus adversely influences functional recovery after total knee arthroplasty: Patients with impaired glycaemic control exhibit poorer functional outcomes at 1-year post-arthroplasty
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