ArticleKnee surgery, sports traumatology, arthroscopy : official journal of the ESSKA2025
Diabetes and total knee arthroplasty: A nationwide analysis of complications, hospitalization outcomes and revision burden.
Article in Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers.
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Who cites it
9 citing papers in PubMed.
- Infection prevention in total knee arthroplasty: current concepts, controversies, and a clinical algorithm.European journal of translational myology · 2026Article
- Perioperative outcomes of total and unicompartmental knee arthroplasty in patients with Type 2 diabetes mellitus: A propensity score-matched analysis.Journal of experimental orthopaedics · 2026Article
- Article
- Metformin Use Is Associated With Reduced Inflammation and Pain After Total Knee Arthroplasty in Patients With Type 2 Diabetes.Orthopaedic surgery · 2026Article
- Primary knee arthroplasty in Sweden: A nationwide analysis of all-cause 30-day mortality and impact of age and ASA-class.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2026Observational
- Cost-analysis of total knee arthroplasty with robot-assisted surgery versus conventional approach.Journal of robotic surgery · 2026Article
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- Article
- Diabetes and total knee arthroplasty: A nationwide analysis of complications, hospitalization outcomes and revision burden.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2025Article
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7 authors.
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Abstract
purposeTotal knee arthroplasty (TKA) is a frequently performed surgical procedure aimed at reducing pain, improving mobility, and restoring function in patients with advanced knee osteoarthritis. As patients undergoing TKA age, the prevalence of comorbidities, particularly diabetes, continues to rise. This study assesses post-operative complications, healthcare costs and hospital length of stay (LOS) among diabetic patients undergoing primary and revision TKA using nationwide data from the NIS database, employing propensity score matching (PSM) to minimize confounding variables. We hypothesized that diabetic patients undergoing TKA would experience higher complication rates, greater healthcare costs and longer hospital stays compared to non-diabetic controls.
methodsThis retrospective cohort analysis utilized data from the Nationwide Inpatient Sample from 2016 to 2019, including a total of 2,602,484 TKA patients: 561,340 with type 2 diabetes and 2,041,144 without diabetes. PSM was applied to create balanced cohorts, adjusting for baseline demographic and clinical differences. Outcomes analyzed included LOS, total hospitalization charges, post-operative complications and revision surgery rates. Statistical significance was set at p < 0.05.
resultsFollowing PSM, diabetic patients exhibited significantly higher risks for post-operative complications, including sepsis, heart failure and surgical site infections, compared to matched non-diabetic controls. Diabetic patients also incurred significantly greater hospital charges ($64,694 vs. $59,952, p < 0.001). In revision TKA cases, diabetic patients demonstrated slightly longer LOS (3.5 days vs. 3.0 days, p < 0.001) and higher total hospital charges ($101,457 vs. $96,614, p = 0.015).
conclusionsDiabetic patients undergoing TKA experience significantly higher complication rates, hospital charges and revision surgery burden. Orthopaedic surgeons and perioperative teams should implement personalized perioperative management strategies, including optimized glycaemic control, cardiovascular risk assessment and infection prevention measures, to mitigate these risks and improve clinical outcomes. LEVELS OF EVIDENCE: Level III.
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