Department of Orthopaedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul 07441, Republic of Korea.
Department of Internal Medicine, Hanyang University Seoul Hospital, Hanyang University College of Medicine, Seoul 04763, Republic of Korea.
Medicina (Kaunas). 2024 Oct 26;60(11):1757. doi: 10.3390/medicina60111757.
: Total knee arthroplasty (TKA) is an effective treatment option for severe knee osteoarthritis. Understanding the impact of diabetes mellitus (DM) on postoperative outcomes is crucial for improving patient satisfaction after TKA. This study aimed to investigate the influence of DM on postoperative complications and mortality after TKA. : We conducted a systematic review and meta-analysis by searching relevant studies published before December 2023 in the PubMed, EMBASE, Cochrane Library, Medline, and Web of Science databases. The assessment included demographic data, comorbidities, and postoperative complications after primary TKA for both DM and non-DM patients. The odds ratio (OR) was used to represent the estimate of risk of a specific outcome. : Thirty-nine studies were finally included in this meta-analysis. Patients with DM had higher rates of periprosthetic joint infection (OR: 1.71, 95% confidence interval [CI]: 1.46-2.00, < 0.01) and prosthesis revision (OR: 1.37, 95% CI: 1.23-1.52, < 0.01). Moreover, patients with DM showed an elevated incidence of pneumonia (OR: 1.54, 95% CI: 1.15-2.07, < 0.01), urinary tract infection (OR: 1.86, 95% CI: 1.07-3.26, = 0.02), and sepsis (OR: 1.61, 95% CI: 1.46-1.78, < 0.01). Additionally, the postoperative risk of cardiovascular (OR: 2.49, 95% CI: 1.50-4.17, < 0.01) and cerebrovascular (OR: 2.38, 95% CI: 1.48-3.81, < 0.01) events was notably higher in patients with DM. The presence of DM increased the risk of deep vein thrombosis (OR: 1.58, 95% CI: 1.22-2.04, < 0.01), but did not lead to an increased risk of pulmonary embolism. Most importantly, DM was associated with a higher mortality rate within 30 days after TKA (OR: 1.27, 95% CI: 1.02-1.60, = 0.03). : Patients with DM exhibited a higher rate of postoperative complications after TKA, and DM was associated with a higher mortality rate within 30 days after TKA. It is crucial to educate patients about the perioperative risk and develop evidence-based guidelines to prevent complications after TKA.
全膝关节置换术（TKA）是治疗严重膝骨关节炎的有效方法。了解糖尿病（DM）对术后结果的影响对于提高 TKA 后患者的满意度至关重要。本研究旨在探讨 DM 对 TKA 后术后并发症和死亡率的影响。
我们通过检索 2023 年 12 月前在 PubMed、EMBASE、Cochrane 图书馆、Medline 和 Web of Science 数据库中发表的相关研究，进行了系统评价和荟萃分析。评估包括原发性 TKA 后 DM 和非 DM 患者的人口统计学数据、合并症和术后并发症。比值比（OR）用于表示特定结果的风险估计。
最终，这项荟萃分析纳入了 39 项研究。DM 患者的假体周围关节感染（OR：1.71，95%置信区间[CI]：1.46-2.00， < 0.01）和假体翻修（OR：1.37，95%CI：1.23-1.52， < 0.01）的发生率更高。此外，DM 患者肺炎（OR：1.54，95%CI：1.15-2.07， < 0.01）、尿路感染（OR：1.86，95%CI：1.07-3.26， = 0.02）和脓毒症（OR：1.61，95%CI：1.46-1.78， < 0.01）的发生率也升高。此外，DM 患者术后心血管（OR：2.49，95%CI：1.50-4.17， < 0.01）和脑血管（OR：2.38，95%CI：1.48-3.81， < 0.01）事件的风险显著增加。DM 增加了深静脉血栓形成（OR：1.58，95%CI：1.22-2.04， < 0.01）的风险，但并未导致肺栓塞风险增加。最重要的是，DM 与 TKA 后 30 天内死亡率升高相关（OR：1.27，95%CI：1.02-1.60， = 0.03）。
综上所述，DM 患者 TKA 后术后并发症发生率较高，且 DM 患者 TKA 后 30 天内死亡率较高。教育患者围手术期风险并制定基于证据的指南以预防 TKA 后并发症至关重要。
