V.V. GURYEV^1,2, M.V. PARSHIKOV¹, N.V. YARYGIN¹, A.A. PROSVIRIN¹, M.V. GOVOROV¹, L.V. IVANOV¹, V.G. BOSYX¹

 ¹Moscow State Medical and Dentistry University named after A.I. Evdokimov, Moscow

²Clinical Hospital «RZhD-Meditsina» named after N.A. Semashko, Moscow

 Contact details:

Parshikov M.V. — MD, Professor of the Department of the Department of Traumatology, Orthopedics and Medicine of Catastrophes

Address: 20 Delegatskaya St., building 1, Moscow, Russian Federation, 129090, tel.: +7-903-207-30-95, e-mail: parshikovmikhail@gmail.com

A comparative assessment of knee joint alloplasty (KJA) results in patients with gonarthrosis with and without concomitant pathology of type 2 diabetes mellitus (DM 2) was carried out. The data of 104 patients were analyzed, who underwent prosthetics of the knee joints in 2003–2020 at the Center for Traumatology and Orthopedics at the Semashko Russian Railways Hospital (mean age 65,2 (10,5) years, mean observation period — 14 years, from 4 to 17 years). Primary total knee arthroplasty was performed with cement prostheses manufactured by Biomet (Aigisi, Avangard) and Eskulap. The patients were divided into 2 groups: group 1 – 56 patients without signs of DM, group 2 — 48 patients with DM. Comparison of the characteristics of patients without diabetes and with DM2 who underwent KJA showed that there were no signifcant differences in the incidence of intraoperative complications; patients with DM2 had slightly longer inpatient treatment and frequency of postoperative complications. Analysis of the clinical and functional state using the Knee Society Score indicated that in patients without diabetes the dynamics of improvement in the functional status of the knee joint was slightly more pronounced, and after 1 year there were statistically signifcant differences in terms of this scale. Evaluation of long-term complications over a long observation period showed that the absolute majority of patients in both groups had no complications; however, in the group of patients with diabetes, the proportion of patients without complications was slightly lower than among patients without DM: 25,0 and 5,4% respectively. It was concluded that, during the decision-making on arthroplasty, surgical risk should be assessed for patients with diabetes, taking into account possible complications and the presence of other associated diseases. One of the main goals of the preoperative preparation of the considered patient category should be the stabilization of the blood plasma glucose level.

Key words: joint replacement, diabetes mellitus, insulin, hip joint, knee joint, glycemic control.

REFERENCES

1. Edwards P.K., Mears S.C., Stambough J.B. et al. Choices, Compromises, and Controversies in Total Knee and Total Hip Arthroplasty Modifiable Risk Factors: What You Need to Know. J. Arthroplasty, 2018, Feb 23. [Epubaheadofprint]
2. Prokhorenko V.M., Azizov M.Zh., Shakirov Kh.Kh. Concomitant diseases in patients with revision hip arthroplasty. Acta Biomedica Scientifica, 2017, no. 2 (5), pp. 136–140 (in Russ.).
3. Berenbraum F. Diabetes-induced osteoarthritis: from new paradigm to a new phenotype. Ann. Rheum. Dis, 2011, vol. 70 (8), pp. 1354–1356.
4. Borenstein T.R., Anand K., Li Q. et al. A Review of Perioperative Complications of Outpatient Total Ankle Arthroplasty. Foot Ankle Int, 2018, vol. 39 (2), pp. 143–148.
5. Namba R.S., Inacio M.C.S., Paxton E.W. Risk Factors Associated with Deep Surgical Site Infections After Primary Total Knee Arthroplasty An Analysis of Knees. J. Bone Joint Surg. Am, 2013, vol. 95 (9), pp. 775–782.
6. Jamsen E., Peltola M., Eskelinen A., Lehto M.U. Comorbid diseases as predictors of survival of primary total hip and knee replacements: a nationwide register-based study of 96 754 operations on patients with primary osteoarthritis. Ann. Rheum. Dis, 2013, vol. 72, pp. 1975–1982.
7. Boddapati V., Fu M.C., Schairer W.W. et al. Revision Total Shoulder Arthroplasty is Associated with Increased Thirty-Day Postoperative Complications and Wound Infections Relative to Primary Total Shoulder Arthroplasty. HSS J, 2018, vol. 14 (1), pp. 23–28.
8. Akhtyamov I.F., Rimashevskiy D.V., Kurmangaliev E.D.T. et al. Prevention of infectious complications of knee arthroplasty. Prakticheskaya meditsina, 2014, no. 4–2 (80), pp. 23–28 (in Russ.).
9. Fadeev E.M., Bubnova N.A., Sinenchenko G.I., Tkachenko A.N. Possibilities of predicting local pyoinflammatory complications in knee arthroplasty (literature review). Zhurnal nauchnykh statey Zdorov’e i obrazovanie v XXI v, 2016, no. 18 (8), pp. 34–41 (in Russ.).
10. Richards J.E., Kauffmann R.M., Zuckerman S.L. et al. Relationship of hyperglycemia and surgical-site infection in orthopedic surgery. J. Bone Joint Surg Ser A, 2012, vol. 94 (13), pp. 1181–1186.
11. Karunakar Madhav A., Kurtis S. Does stress-induced hyperglycemia increase the risk of peri-operative infectious complications in orthopedic trauma patients? J. Orthop. Trauma, 2010, vol. 24 (12), pp. 752–756.
12. Pedersen A.B., Mehnert F., Johnsen S.P., Sorensen H.T. Risk of revision of a total hip replacement in patients with diabetes mellitus: a population-based follow up study. J. Bone Joint Surg. Br., 2010, vol. 92, pp. 929–934.
13. Zmistowski B., Tetreault M., Alijanipour P. et al. Recurrent periprosthetic joint infection: persistent or new infection? J. Arthroplasty, 2013, vol. 28, pp. 1486–1489.
14. Agos F., Shoda C., Bransford D. et al. Part II: managing perioperative hyperglycemia in total hip and knee replacement surgeries. Nurs Clin North Am, 2014, vol. 49 (3), pp. 299–308.
15. Dhatariya K., Levy N., Kilvert A. et al. NHS Diabetes guideline for the peri-operative management of the adult patient with diabetes. Diabetes Med, 2012, vol. 29, pp. 420–423.