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©The Author(s) 2015.
World J Orthop. Apr 18, 2015; 6(3): 331-339
Published online Apr 18, 2015. doi: 10.5312/wjo.v6.i3.331
Published online Apr 18, 2015. doi: 10.5312/wjo.v6.i3.331
Table 1 Complications of diabetes potentially affecting orthopaedic surgery patients
Retinopathy |
Visual impairment leading to falls |
Peripheral neuropathy |
Balance issues |
Gait abnormalities |
Lack of protective sensation |
Increased risk of surgical site infection |
Increased risk of nonunion |
Peripheral artery disease |
Impaired lower extremity blood supply leading to faulty healing |
End stage renal disease |
Metabolic bone disease |
Anemia of chronic disease |
Poorly controlled diabetes (hyperglycemia) |
Increased risk of surgical site infection |
Impaired bone and soft tissue healing |
Table 2 Impact of diabetes on orthopaedic surgical subspecialties
Foot and ankle surgery |
Increased risk of surgical site infection |
Increased risk of nonunion, malunion and hardward failure |
Increased risk of neuropathic ulcers |
Spine surgery |
Increased risk of surgical site infection |
Increased risk of nonroutine discharges |
Sports medicine |
Impaired healing of soft tissues (ligaments and tendons) |
Spontaneous necrosis of muscle |
Total joint arthroplasty |
Increased risk of surgical site infection |
Increased risk of nonroutine discharges |
Upper extremity |
Increased risk of nerve compression syndromes |
Increased risk of overuse syndromes |
Inferior outcomes in rotator cuff repair and frozen shoulder |
Table 3 Take home messages for orthopaedic surgeons treating diabetic patients
Optimize the patient’s medical care preoperatively |
Strive for long term glycemic control of HbgA1c ≤ 8% |
Thorough preoperative workup for cardiovascular disease |
Identify anemia if present and treat accordingly if major blood loss is anticipated (i.e., spine surgery or total joint surgery) |
Thorough assessment of the vascular system preoperatively |
If an abnormal examination is present proceed with non-invasive testing and vascular consultation |
Perioperative care |
Strive for inpatient glycemic control as recommended by major societies |
Pre-meal glucose of < 140 mg/dL |
Random glucose of < 180 mg/dL |
Avoid hypoglycemia!! |
Glucose levels of > 200 mg/dL have been associated with increased rates of complications in orthopaedic patients |
Recognize that patients with poorly controlled diabetes and comorbidities are at increased for postoperative complications |
Cardiovascular complications |
Myocardial infarction |
Stroke |
Deep vein thrombosis and pulmonary embolism |
Infection |
Surgical site |
Urinary tract |
Pneumonia |
Iatrogenic pressure ulcers |
Pad bony prominences such as the sacrum and heels |
Noninfectious complications |
Hardward failure |
Nonunion or malunion |
Impaired wound healing |
Inform patients that local injections of corticosteroids (trigger point injections, epidural steroid injections, etc.) will cause a temporary elevation in serum glucose for 24-48 h |
- Citation: Wukich DK. Diabetes and its negative impact on outcomes in orthopaedic surgery. World J Orthop 2015; 6(3): 331-339
- URL: https://www.wjgnet.com/2218-5836/full/v6/i3/331.htm
- DOI: https://dx.doi.org/10.5312/wjo.v6.i3.331