Diabetes is Associated with an Increased Risk of Arthrofibrosis Following Total Knee Arthroplasty

The relationship between diabetes and arthrofibrosis following total knee arthroplasty (TKA) remains unclear. This study evaluated whether varying levels of preoperative glycemic control, measured by hemoglobin A1c (HbA1c), are associated with arthrofibrosis requiring manipulation under anesthesia (MUA) or arthroscopic lysis of adhesions (aLOA) after TKA.

A retrospective cohort analysis of a healthcare database identified patients who underwent primary TKA between 2006 and 2026. Patients were stratified by preoperative HbA1c: well-controlled (5.7 to 6.9), moderately uncontrolled (7.0 to 7.9), severely uncontrolled (≥ 8.0), and non-diabetic controls (less than 5.7). Propensity score-matched cohorts were assessed for MUA or aLOA rates at less than three months, three to 12 months, and greater than 12 months postoperatively.

Compared with controls, patients who had HbA1c 5.7 to 6.9 had increased odds of MUA or aLOA within three months after TKA (odds ratio (OR) 1.21, 95% confidence interval (CI) 1.07 to 1.37), with no significant differences at three to 12 months or greater than 12 months. Patients who had HbA1c 7.0 to 7.9 demonstrated greater early risk within three months (OR 1.65, 95% CI 1.37 to 1.97), without significant differences at later time points. Patients who had HbA1c ≥ 8.0 demonstrated the highest early risk within three months (OR 1.91, 95% CI 1.35 to 2.71), with no significant difference at three to 12 months; analysis beyond 12 months was limited by suppressed event counts.

Diabetes is associated with an increased risk of arthrofibrosis requiring MUA or aLOA within three months following TKA. Increasing HbA1c levels correlated with progressively higher early arthrofibrosis risk. These findings suggest that worse preoperative glycemic control is associated with an elevated risk of early postoperative arthrofibrosis following TKA.