Elective hip arthroplasty rates and related complications in people with diabetes mellitus

Diabetes mellitus (DM), poor glycaemic control and raised body mass index (BMI) have been associated with postoperative complications in arthroplasty, although the relative importance of these factors is unclear. We describe the prevalence of DM in elective hip arthroplasty in a UK centre, and evaluate the impact of these factors.

We analysed retrospective data for DM patients undergoing arthroplasty over a 6-year period and compared with non-diabetic matched controls (1 DM patient: 5 controls). DM was present in 5.7% of hip arthroplasty patients (82/1443).

Postoperative complications occurred in 12.2% of DM patients versus 12.9% of controls (p = 1.000); surgical complications were present in 6.1% of those with DM and 2.4% of controls (p = 0.087), while medical complications occurred in 8.5% of DM patients versus 10.7% of controls (p = 0.692). Complications developed in 23.1% of DM patients with poor glycaemic control (HbA1c > 53 mmol/mol) versus 9.8% with good control (p = 0.169). In DM patients and controls combined, complications occurred in 16.3% of obese patients versus 10.0% of non-obese patients (p = 0.043). In the DM cohort, 13.7% of overweight patients had complications versus 0% with a normal or low BMI (p = 0.587).

DM rates were lower than expected, and glycaemic control was good. Overall complication rates were unrelated to the presence of DM or to glycaemic control, although surgical complications were observed more frequently in those with DM and poor glycaemic control was uncommon within our cohort. Complications were more frequent in those with a higher BMI. Whether some patients with DM but without an increased risk of complications are currently being excluded from surgery requires exploration.