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

The aim of this study was to investigate the impact of diabetic peripheral neuropathy (DPN) on total knee arthroplasty (TKA) outcomes when compared with both nondiabetic and diabetic patients who did not have neuropathy (DM).

This retrospective cohort study utilized a global clinical research network, comprising data collected between 2005 and 2022. Patients undergoing TKA were identified using international classification of diseases, 10th revision and Current Procedural Terminology codes. Patients were stratified based on diabetes status and the presence of diabetic neuropathy. Orthopaedic complications were assessed over a 2-year period postoperatively, while medical and hospital complications were evaluated within 90 days. Propensity score matching (1:1) was performed to control for baseline covariates, including age, sex, body mass index, Charlson Comorbidity Index, and hemoglobin A1c where applicable. Postmatching logistic regression was used to calculate risk ratios (RRs) with 95% confidence intervals. Statistical analyses were conducted with significance set at P < 0.05.

This study included 318,851 patients who underwent TKA: 227,597 (71.4%) patients who did not have diabetes, 68,694 (21.5%) patients who had diabetes, but did not have diabetic neuropathy, and 22,560 (7.1%) patients who had diabetic neuropathy. When compared to patients who had DM, after matching for hemoglobin A1c levels, patients who had DPN had a higher risk of postoperative joint infection (RR 1.69, P < 0.001), periprosthetic fracture (RR 1.64, P < 0.001), and revision surgery (RR 1.49, P < 0.001) within two years of surgery. Compared to nondiabetic patients, those who had DPN again had significantly higher risks of 2-year orthopaedic complications.

This study found that diabetic neuropathy, when compared with both nondiabetic and diabetic patients who did not have neuropathy, resulted in higher odds of medical and surgical complications following TKA. Specifically, diabetic neuropathy was associated with higher odds of joint infection, periprosthetic fracture, and revision surgery. Orthopaedic surgeons should be aware of the added surgical risk associated with diabetic neuropathy, outside of the impact of diabetes, overall.