SAN FRANCISCO -- Patients with type 1 diabetes were more likely than those with type 2 diabetes to die or develop perioperative complications after undergoing total knee or hip arthroplasty, a review of 65,769 cases found.

The risk of death related to total joint arthroplasty in type 2 diabetes

The investigators used federal data from the 2003 National In patient Sample to compare rates of complications between 8,728 patients with type 1 diabetes and 57,041 patients with type 2 diabetes who underwent primary and revision arthroplasties of the hip or knee from 1998 to 2003. Their analysis was based on regression modeling to control for the potential confounding effects of age, race, gender, and median household income by zip code.

Type 2 diabetes patients were about 30% less likely than type 1 diabetics to develop a urinary tract infection, pneumonia, or postoperative hemorrhage; they were about 50% less likely to develop an infection related to the surgery. The rate of myocardial infarction also was lower in type 2 diabetics, said Dr. Bolognesi of Duke University, Durham, N.C.

Each of the differences they found between groups was statistically significant.

A bivariate analysis that directly compared complications in the two diabetes groups without adjusting for confounders showed that 0.7% with type 1 diabetes and 0.3% with type 2 diabetes died in association with the total joint replacement surgery, he reported. Rates of surgery-associated myocardial infarction were 0.06% with type i diabetes and 0.02% with type 2 diabetes. Perioperative urinary infections occurred in 5% of patients with type I diabetes and in 3% with type 2 diabetes. Pneumonia developed in 0.8% of the type 1 diabetes group and in 0.5% of the type 2 diabetes group.

Postoperative hemorrhage after total knee or hip arthroplasty was seen in 2% of the type 1 diabetes group and in 1% of the type 2 diabetes group. Infection occurred in 0.8% of patients with type I diabetes and in 0.4% with type 2 diabetes.

Each of these differences between groups in the bivariate analysis was statistically significant. Dr. Bolognesi is a consultant to four companies that market orthopedic products, instruments, or implants: ORTHOsoft Inc., DePuy Orthopaedics Inc., Zimmer Inc., and AMEDICA Corp. He owns stock or has stock options in two of those companies.

BY SHERRY BOSCHERT

San Francisco Bureau

Surgery-Associated Complications
In Total Knee or Hip Replacements

                          Type 1 diabetes        Type 2 Diabetes
                        patients (n = 8,728)   patients (n = 57,041)

Myocardial infarction            0.06%                 0.02%
Death                            0.7%                  0.3%
Pneumonia                        0.8%                  0.5%
Urinary infection                5%                    3%

Note: Based on 2003 data for diabetes patients who underwent
primary or revision arthroplasties of the hip or knee.

Source: Dr. Bolognesi

Note: Table made from bar graph.