Outcomes after total joint arthroplasty in patients with and without diabetes mellitus: A TriNetX database study

Up to 25 % of people who undergo total hip arthroplasty (THA) or total knee arthroplasty (TKA) in the United States live with diabetes. Due to variability in complication rates reported between those with and without diabetes who undergo total joint arthroplasty, this study aimed to compare postoperative outcomes up to 5 years after THA or TKA for patients with and without diabetes.

Using the TriNetX database, patients who underwent THA or TKA were categorized into three cohorts: type 2 diabetes mellitus (T2DM), type 1 diabetes mellitus (T1DM), and no diabetes (controls). Propensity matching based on age, race, and ethnicity created comparable cohorts for analysis at 90 days, 2 years, and 5 years, with outcomes assessed using odds ratios and confidence intervals.

After propensity matching, 97,404 T2DM patients were compared to controls, and T2DM patients showed consistently worse outcomes. At 90 days, T2DM patients had 25.7 % higher readmission odds, 12.5 % higher manipulation under anesthesia rates, and 33 % higher rates of infections. At 2 years, individuals with T2DM were more likely to experience episodes of readmission (17 %), revision arthroplasty (13 %), and resection arthroplasty (31 %), escalating to 32 % higher readmissions, and 57 % higher distal femur fracture plating (57 %) at 5 years. The 298 T1DM showed no statistically significant differences compared to controls for any complication.

These findings confirm that patients with T2DM undergoing THA or TKA had significantly greater odds of complications compared to no diabetes controls and indicate the need for close postoperative monitoring to minimize complication risk.