Outcomes of total knee arthroplasty in people with diabetes: An overview of systematic reviews and meta-analysis

Abstract

Background and aims

Total knee arthroplasty (TKA) in people with diabetes is associated with increased risks of postoperative complications. This review evaluates how diabetes influences complication rates and overall outcomes following TKA.

Methods

An overview of systematic reviews and meta-analyses was conducted, with a comprehensive search performed across databases including PubMed, Scopus, Web of Science, and the Cochrane Library. The protocol was registered on PROSPERO on December 12, 2024.

Results

People with diabetes undergoing TKA face a 43 % higher risk of periprosthetic joint infection (PJI) and are 45 % more likely to experience deep vein thrombosis (DVT). The rates of hospital readmissions were significantly higher, showing a 28 % increased likelihood. Subpopulations with insulin-treated diabetes exhibited a 60 % greater incidence of perioperative adverse events. Notably, people with diabetes undergoing TKA had significantly higher odds of developing infection (OR 1.97, 95 % CI 1.48–2.61, p = 0.004) and deep PJI (OR 2.10, 95 % CI 1.49–2.95, p < 0.001). Significantly higher odds of DVT were observed in people with diabetes (OR 1.43, 95 % CI 1.23–1.66, p < 0.0000). Inadequate perioperative glycemic control was identified as a modifiable risk factor, although definitions varied widely across studies.

Conclusions

The presence of diabetes significantly impacts post-TKA outcomes, leading to higher complication rates and negatively affecting physical function and quality of life. Further rigorous studies are needed to establish standardized definitions for glycemic control and to investigate mechanisms contributing to increased risks, facilitating improved preoperative risk stratification and management strategies for diabetic patients undergoing TKA.