Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
Department of Orthopaedic Surgery, National University Hospital, Singapore, Singapore.
J Arthroplasty. 2021 Jul;36(7):2486-2491. doi: 10.1016/j.arth.2021.02.070. Epub 2021 Mar 4.
Diabetes is one of the most common comorbidities in patients undergoing total knee arthroplasty (TKA) for osteoarthritis. However, the evidence remains unclear on how it affects patient-reported outcome measures after TKA.
We reviewed prospectively collected data of 2840 patients who underwent primary unilateral TKA between 2008 and 2018, of which 716 (25.2%) had diabetes. All patients had their HbA1c measured within 1 month before surgery, and only well-controlled diabetics (HbA1c <8.0%) were allowed to proceed with surgery. Patient demographics and comorbidities were recorded, and multiple regression was performed to evaluate the impact of diabetes on improvements in patient-reported outcome measures (Short Form 36 (SF-36), Western Ontario and McMaster University Osteoarthritis Index (WOMAC), Knee Society Score (KSS)) and knee range of motion (ROM).
Compared with nondiabetics, patients with diabetes were more likely to possess a higher body mass index (P-value <.001), more comorbidities (P-value <.001), and poorer preoperative SF-36 Physical Component Summary (PCS) (P-value <.001), WOMAC (P-value = .002), KSS-function (P-value <.001), and knee ROM (P-value <.001). Multiple regression showed that diabetic patients experienced marginally poorer improvements in KSS-knee (-1.22 points, P-value = .025) and knee ROM (-1.67°, P-value = .013) than nondiabetics. However, there were no significant differences in improvements for SF-36 PCS (P-value = .163), Mental Component Summary (P-value = .954), WOMAC (P-value = .815), and KSS-function (P-value = .866).
Patients with well-controlled diabetes (HbA1c <8.0%) can expect similar improvements in general health and osteoarthritis outcomes (SF-36 PCS and Mental Component Summary, WOMAC, and KSS-function) compared with nondiabetics after TKA. Despite having marginally poorer improvements in knee-specific outcomes (KSS-knee and knee ROM), these differences are unlikely to be clinically significant.
糖尿病是骨关节炎患者行全膝关节置换术（TKA）的最常见合并症之一。然而，关于它如何影响 TKA 后的患者报告结局测量指标，证据仍不清楚。
我们回顾性分析了 2008 年至 2018 年间接受初次单侧 TKA 的 2840 例患者的前瞻性收集数据，其中 716 例（25.2%）患有糖尿病。所有患者均在手术前 1 个月内测量了糖化血红蛋白（HbA1c），只有血糖控制良好的糖尿病患者（HbA1c<8.0%）才允许进行手术。记录患者的人口统计学和合并症数据，并进行多元回归分析，以评估糖尿病对患者报告结局测量指标（36 项简短健康调查量表（SF-36）、西部安大略省和麦克马斯特大学骨关节炎指数（WOMAC）、膝关节协会评分（KSS））和膝关节活动度（ROM）改善的影响。
与非糖尿病患者相比，糖尿病患者更有可能具有更高的体重指数（P 值<.001）、更多的合并症（P 值<.001）和较差的术前 SF-36 生理成分综合评分（PCS）（P 值<.001）、WOMAC（P 值=.002）、KSS-功能（P 值<.001）和膝关节 ROM（P 值<.001）。多元回归分析显示，与非糖尿病患者相比，糖尿病患者的 KSS-膝关节（-1.22 分，P 值=.025）和膝关节 ROM（-1.67°，P 值=.013）改善情况略差。然而，SF-36 PCS（P 值=.163）、心理成分综合评分（P 值=.954）、WOMAC（P 值=.815）和 KSS-功能（P 值=.866）的改善情况无显著差异。
血糖控制良好的糖尿病患者（HbA1c<8.0%）在接受 TKA 后，与非糖尿病患者相比，在总体健康和骨关节炎结局（SF-36 PCS 和心理成分综合评分、WOMAC 和 KSS-功能）方面可预期有相似的改善。尽管在膝关节特定结局（KSS-膝关节和膝关节 ROM）方面的改善略差，但这些差异可能无临床意义。
