DOS BULLETIN - Dansk Ortopædisk Selskab

2010-378_DOS nr. 3 2010 29/09/10 10:08 Side 76
Risk for revision among total hip arthroplasty
patients with dia-betes mellitus in Denmark
Alma B. Pedersen, Frank Mehnert,
Søren P. Johnsen,
Henrik Toft Sørensen
Department of Clinical Epidemiology, Aarhus University Hospital
Background: As a consequence of the rising prevalence of diabetes
worldwide, an increasing proportion of diabetic THR patients may be
expected in coming years. Diabetes research on postoperative complications
among arthroplasty patients is limited.
Purpose: We evaluated the extent to which diabetes affect the revision
rate due to aseptic loosening, deep infection and dislocation following
total hip arthroplasty (THA).
Methods: We used the Danish Hip Arthroplasty Registry (DHR) to identify
all primary THR patients operated on during the period from 1 January
1996 to 31 December 2005. The presence of diabetes among THA
patients was identified by using The Danish National Registry of
Patients and The Danish National Drug Prescription Database. We used
Poisson regression analyses, to estimate relative risk (RR) and 95% Confidence
Interval (CI) for patients with diabetes compared to patients
without diabetes, both crude and adjusted for potentially confounding
factors.
Findings: We identified 57 575 first primary THR patients in DHR, of
which 3 278 (5.7%) were with diabetes and 54 297 (94.3%) without diabetes.
An adjusted RR for revision due to deep infection of 1.45 (CI:
1.00-2.09) was found for THA diabetic patients compared to patients
without diabetes. This increased risk accrues particularly to THR
patients with type 2 diabetes (RR=1.49 (95% CI: 1.02- 2.18)), those with
diabetes for less than five years prior to THR (RR=1.69 (95% CI: 1.24-
2.32)), those with complications due to diabetes (RR=2.11 (95% CI:
1.41- 3.17)), and those with cardiovascular comorbidities prior to surgery
(RR=2.35 (95% CI: 1.39-3.98)).
Conclusion: Patients and surgeons should be aware of the relatively elevated
risk of revision due to deep infection following THR in diabetics
compared with non-diabetics, particularly among patients with insufficient
control of glucose level.
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