Hip and Knee Osteoarthritis in Patients with Non-Insulin Dependent Diabetes Mellitus

Transcription

1 Hip and Knee Osteoarthritis in Patients with Non-Insulin Dependent Diabetes Mellitus Laurie L. Jansky, MS, Zbigniew Gugala, MD, PhD. The University of Texas Medical Branch, Galveston, TX, USA. Disclosures: L.L. Jansky: None. Z. Gugala: None. Introduction: Non-insulin dependent diabetes mellitus (NIDDM) affects 25.8 million (8.3%) people in the United States.[1]. Among numerous NIDDM-associated complications are hypertension, kidney, neurologic, vision, heart diseases, stroke, amputation, but also many musculoskeletal disorders, including adhesive capsulitis, Dupuytren s contracture, carpal tunnel syndrome, degenerative spondylitis, and Charcot arthropathy [2,3]. Additionally, diabetes patients exhibit an increased risk for hip and vertebral fractures due to low bone mineral content [4]. Despite ongoing research interests to determine the potential association between NIDDM and osteoarthritis (OA), not until recently has a study suggested that NIDDM may be an independent risk factor for developing major joint OA [5].The objectives of the study were: to determine the prevalence of NIDDM in patients who underwent primary total hip or knee arthroplasty for severe OA; to associate the duration, course, and complications of NIDDM with severe hip and knee OA culminating with arthroplasty; and to assess the risk of developing severe hip and knee OA in NIDDM. Methods: The study was a retrospective chart review of 500 consecutive total hip (THA) and total knee arthroplasty (TKA) patients performed at the University of Texas Medical Branch between Jan 7, 2008 and Apr 1, The 250 THA and 250 TKA medical records were reviewed which met the following criteria: inclusion: a UTMB patient identified by ICD-10 code as 8151 (THA) or 8154 (TKA); and exclusion: THA or TKA due to fracture, post-traumatic arthritis, rheumatoid arthritis, avascular necrosis, revision arthroplasty, or incomplete medical record. The data included patient demographics (age, gender, ethnicity); body mass index (BMI); presence or absence of diabetes; diabetes type; level of glycosylated hemoglobin (HbA1c); time from the diagnosis of diabetes to THA or TKA; contralateral joint pathology; comorbidities (hypertension, dyslipidemia); complications associated with arthroplasty and/or diabetes (peripheral neuropathy, micro- and macroangiopathy, nephropathy). The collected data were tabulated according to diabetes status and analyzed/compared using descriptive statistics (multiple regression, t-test; significance threshold <0.05). Results: The study identified 137 THA and 223 TKA eligible patients who underwent arthroplasty for severe OA. The prevalence of NIDDM among these patients was 26 (18.3%) and 54 (24.2%) for THA and TKA, respectively, and the incidence of bilateral major joint OA and other joint arthroplasty are depicted in Figure 1. The course and duration of NIDDM in the THA and TKA patients are illustrated in Figure 2. The demographic and medical patients characteristics are summarized in Table 1. Discussion: Because of similar incidences of OA among patients with BMI30 with or without diabetes, the study suggests NIDDM as a risk factor independent of obesity for developing severe hip or knee OA. Despite acceptable glycemic control (HbA1c<7) in most patients, severe hip or knee OA requiring arthroplasty developed in average within 9.17 and years of diabetes duration, respectively. NIDDM is associated with 1.4- and 1.5-times higher rates of bilateral OA and other joint arthroplasty, respectively. This suggests more rapid joint destruction and/or more advanced stage of OA at the time of joint arthroplasty. Peripheral neuropathy was present in 42.3% of THA and 18.6% of TKA diabetes patients. Impaired sensory feedback likely resulted in masking joint-related symptoms, thereby enhancing progression of joint destruction and delaying arthroplasty. Significance: Orthopaedic management of THA and TKA patients with non-insulin dependent diabetes mellitus requires attention to the related musculoskeletal risks and/or complications. Acknowledgments: References: 1. Centers for Disease Control and Prevention. National diabetes fact sheet. Atlanta, GA. U.S. Department of Health and Human Services, Douloumpakas I, et al. Hippokratia 2007;11: Smith LL, et al. Br J Sports Med 2003;37: Janghorbani M, et al. Am J Epidemiol 2007;166: Schett G, et al. Diabetes Care 2013;36:403-

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4 ORS 2014 Annual Meeting Poster No: 0367

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