Arthroplasty for Younger Diabetics Predicted to Increase

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DENVER — A new VA study raises the specter of growing demand for joint arthroplasty by younger patients with diabetes.

The report, based on research conducted at the VA Eastern Colorado Health Care System in Denver and the VA Medical Center in East Orange, NJ, was published recently in the journal Clinical Orthopaedics and Related Research.

“A future increase in total joint arthroplasties in patients with diabetes seems likely, considering the prevalence of osteoarthritis and diabetes mellitus are increasing,” the authors wrote in the article’s background. “However, the rates of arthroplasty in the population of patients with diabetes are unclear.

Researchers sought to determine whether lower extremity arthroplasties in a veteran population with diabetes is different from a similar population without diabetes, asking:

  1. Is the rate of total knee arthroplasty (TKA) in veterans with diabetes higher than in those without diabetes?
  2. Is the rate of total hip arthroplasty (THA) in veterans with diabetes higher than in those without diabetes?
  3. Are arthroplasty revision rates greater in veterans with diabetes than in veterans without diabetes?

To help answer those questions, investigators used the VHA’s administrative data from fiscal year 2000 to identify patients with primary or secondary TKA or THA. The rate of surgeries among diabetic veterans was compared with that among a non-diabetic population.

Researchers found that the diabetic cohort received total joint arthroplasties at a higher rate than the non-diabetic cohort at all ages younger than 66 years, with a range of odd ratios from 1.3 to 3.4.

Results also indicated that the rate of TKA (95% CI, 2.1–3.7), the rate of THA (95% CI, 1.0–2.6), and the rates of arthroplasty revision (95% CI, 0.9–5.8 TKA and 0.7–6.8 THA) all were higher in veterans with diabetes.

The authors further noted that “those with diabetes in the youngest age group studied received total joint arthroplasties and revision surgeries at approximately double the rates of those without diabetes.”

1. King KB, Findley TW, Williams AE, Bucknell AL. Veterans with diabetes receive arthroplasty more frequently and at a younger age. Clin Orthop Relat Res. 2013

Sep;471(9):3049-54. doi: 10.1007/s11999-013-3026-3. Epub 2013 May 7. PubMed PMID: 23649224; PubMed Central PMCID: PMC3734424.

 

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