| Osteoarthritis of knee is a degenerative disease characterized by the degeneration of articular cartilage and the formation of osteophyte, with which the patients feel painful, acquire malformation of the knee, and be inflexible to move the knee joint. To those patients with the end stage osteoarthritis of the knee, the only effective treatment is Total Knee Arthroplasty (TKA), whose indication is for the patients more than 55 years old, with pain, malformation and instability of the knee. A investigation based on large population in China revealed the incidence of diabetes mellitus in people over 60 was 20.4%, suggesting 8.55% patients with osteoarthritis also suffers from diabetes mellitus. When stress, such as trauma and operation was imposed, the level of blood glucose may dramatically increase in the patients with diabetes mellitus due to impaired glucose tolerance, inducing perioperative complications. Therefore, to explore the range of increase of postoperative blood glucose is paramount to avoid occurrence of complications.Objective:To explore the influence of primary TKA on the level of blood glucose in patients with type II diabetes mellitus, and to investigate the effect of hyperglycemia on perioperative blood loss and short-term effectiveness in primary TKA.Method:We retrospectively investigated 23 patients (23 knees) with type II diabetes mellitus who underwent TKA (Group A) in Qilu hospital during August,2012 to August,2013, as well as 51 patients without diabetes (Group B). All patients were diagnosed with osteoarthritis of knee and presented with pain. There are 3 males (3 knees) and 20 females (20 knees) among patients in group A, with an average age of 67.7 years (range,60-77 years). The ages of patients in group B ranges from 57 years to 76 years, with an average age of 66.8 years. The patients in group B included 8 males (8 knees) and 43 females (43 knees). We recorded the clinical parameters including gender, age, affected side, body mass index (BMI), the level of preoperative hemoglobin (Hb) and preoperative hematocrit (Hct), and no statistical significance was found between these two groups (P>0.05). At admission time, the average blood glucose was 9.4+3.0 mmol/L, with a urine glucose range (-) to (+++). Through treatment, the TKA was performed when the fasting blood glucose<7.8 mmol/L, and 2h postpradndial blood glucose<10.0 mmol/L. We recorded the level of preoperitive blood glucose at 6am on the operation day, as well as the level of postoperative blood glucose at 22pm, and the level of fasting blood glucose in 5 consecutive days after the operation. Then compared them with the 6am preoperative blood glucose level. Furthermore, we compared the clinical parameters including preoperative Hospital for Special Surgery (HSS) score and HSS score 3 months after TKA, postoperative Hb and Hct, dominant blood loss, hidden blood loss and theoretical total blood loss between two groups. Statistical significance was confirmed when P<0.05.Results:All patients were received unilateral TKA, and the average blood glucose of patients in group A at 6am was 6.7±1.4 mmol/L, with the average duration of the operation was 100.3±36.1 min. The average of postoperative blood glucose at 22pm was 10.8±3.0 mmol/L, and average level of fasting blood glucose in 5 consecutive days was 9.5±1.6 mmol/L,8.6±1.7 mmol/L,8.4±1.1 mmol/L,8.0±1.3 mmol/L, 7.9±1.4 mmol/L respectively. Statistical significance was found between the level of preoperative fasting blood glucose and postoperative blood glucose (P<0.05). Blood transfusion was administrated in 2 cases (11.1%) from group A and 4 cases (7.8%) from group B, and there was no statistical significance in the rate of blood transfusion between the two groups (P>0.05). No statistical significance was found in the theoretical total blood loss between two groups, as well as in Hb and Hct 2 days after TKA (P>0.05). While the perioperative dominant blood loss of patients from group A was significantly elevated (P<0.05), interestingly, the hidden blood loss decreased remarkably (P<0.05). Moreover, both preoperative and postoperative HSS scores in patients from group A are significantly lower than that in patients from group B (P< 0.05). The wound of all patients healed by first intention, and no related complications was observed.Conclusion:Among the patients with type Ⅱ diabetes mellitus who receives TKA, the postoperative level of blood glucose increases significantly during the first day after operation, and decreses slightly in the second day, then maintains at a relatively high level. When compared with patients without type Ⅱ diabetes mellitus, a decreased HSS score was found in patients with type Ⅱ diabetes mellitus. Despite the maintained theoretical total blood loss and the decreased hidden blood loss, elevated perioperative dominant blood loss was found to be significantly, implicating a necessity in fluid infusion during the operation. Furthermore, the decreased HSS scores both before and after TKA may reflect an adverse effect of type Ⅱ diabetes mellitus on both osteoarthritis and short-term effectiveness of TKA. |
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