Diabetic Neuropathy Is a Strong Risk Factor for Poor Orthopaedic Outcomes Following Total Knee Arthroplasty.

Area of Science:

• Orthopaedic Surgery
• Diabetology
• Neurology

Background:

• Diabetic peripheral neuropathy (DPN) is a common complication of diabetes mellitus.
• The impact of DPN on outcomes following total knee arthroplasty (TKA) remains incompletely understood, particularly when compared to diabetic patients without neuropathy.

Purpose of the Study:

• To investigate the impact of diabetic peripheral neuropathy (DPN) on total knee arthroplasty (TKA) outcomes.
• To compare TKA outcomes in patients with DPN versus nondiabetic patients and diabetic patients without neuropathy.

Main Methods:

• Retrospective cohort study utilizing a global clinical research network (2005-2022).
• Patients undergoing TKA identified via ICD-10 and CPT codes, stratified by diabetes and DPN status.
• Propensity score matching (1:1) and logistic regression used to assess 2-year orthopaedic and 90-day medical/hospital complications.

Main Results:

• Included 318,851 TKA patients: 227,597 non-diabetic, 68,694 diabetic without DPN, 22,560 with DPN.
• DPN patients showed higher risks of joint infection (RR 1.69), periprosthetic fracture (RR 1.64), and revision surgery (RR 1.49) within 2 years compared to diabetic patients without neuropathy.
• DPN patients also had significantly higher risks of 2-year orthopaedic complications compared to nondiabetic patients.

Conclusions:

• Diabetic peripheral neuropathy significantly increases the odds of medical and surgical complications after TKA.
• DPN is independently associated with higher risks of joint infection, periprosthetic fracture, and revision surgery post-TKA.
• Orthopaedic surgeons must consider the heightened surgical risk posed by DPN, beyond the general effects of diabetes.