Department of Orthopedic Surgery, Chonnam National University Hospital, 42 Jebongro, Donggu, Gwangju, 61469, Republic of Korea.
Department of Orthopedic Surgery, Chonnam National University Medical School, Gwangju, Republic of Korea.
J Orthop Surg Res. 2023 Aug 29;18(1):636. doi: 10.1186/s13018-023-04110-y.
It is still uncertain whether diabetes mellitus (DM) is a risk factor for poor outcomes and increased complications after total ankle arthroplasty (TAA). The objective of this study was to compare clinical outcomes and complication rates of TAA in patients with and without DM.
This study enrolled patients with symptomatic end-stage ankle osteoarthritis with a minimum follow-up period of 24 months after TAA. A total of 252 patients (266 ankles) were classified into two groups according to the presence of DM: (1) DM group (59 patients, 67 ankles) and (2) non-DM group (193 patients, 199 ankles). We defined controlled diabetes as (1) HbA1c level < 7.0%, or (2) fasting glucose level < 130 mg/dL with HbA1c level ≥ 7.0% for hospitalization period. Clinical outcomes data (Ankle Osteoarthritis Scale, American Orthopedic Foot and Ankle Society ankle-hindfoot score, Short Form-36 Physical Component Summary score, and visual analog scale for pain) were compared preoperatively and at the final follow-up between the two groups. Complications following TAA were also compared between the two groups.
All clinical variables had improved in both groups by the final follow-up (mean follow-up = 77.8 months). There was no significant difference in any clinical variable between the two groups at the final follow-up (P > 0.05). Of the 266 ankles, 73 ankles (19 in the DM group, 54 in the non-DM group) developed periprosthetic osteolysis. Although the DM group showed a higher prevalence of aseptic loosening or subsidence, the difference between the two groups was not statistically significant (P = 0.236).
In the intermediate-term follow-up, TAA in patients with controlled DM showed clinical outcomes and complication rates comparable to patients without DM. Our results suggest that TAA can be done safely in diabetic patients if the DM is controlled in the perioperative period.
Therapeutic Level III.
糖尿病（DM）是否是全踝关节置换（TAA）后不良结局和并发症增加的危险因素仍不确定。本研究的目的是比较有和无 DM 的 TAA 患者的临床结果和并发症发生率。
本研究纳入了有症状的终末期踝关节骨关节炎患者，TAA 后至少随访 24 个月。根据是否存在 DM，将 252 例患者（266 个踝关节）分为两组：（1）DM 组（59 例，67 个踝关节）和（2）非 DM 组（193 例，199 个踝关节）。我们将控制良好的糖尿病定义为（1）HbA1c 水平<7.0%，或（2）住院期间空腹血糖水平<130mg/dL 但 HbA1c 水平≥7.0%。比较两组患者术前和末次随访时的临床结果数据（踝关节骨关节炎量表、美国矫形足踝协会踝关节后足评分、SF-36 健康调查简表生理成分评分和疼痛视觉模拟评分）。比较两组 TAA 后的并发症。
两组患者所有临床变量在末次随访时均得到改善（平均随访时间=77.8 个月）。两组患者在末次随访时的任何临床变量均无显著差异（P>0.05）。266 个踝关节中，73 个（DM 组 19 个，非 DM 组 54 个）出现假体周围骨溶解。尽管 DM 组无菌性松动或下沉的发生率较高，但两组间差异无统计学意义（P=0.236）。
在中期随访中，控制良好的 DM 患者的 TAA 显示出与无 DM 患者相当的临床结果和并发症发生率。我们的结果表明，如果围手术期控制好 DM，TAA 可安全用于糖尿病患者。
治疗性研究 III 级。
