Clinical Orthopaedics and Related Research: September 2013 - Volume 471 - Issue 9 - p 3049–3054 doi: 10.1007/s11999-013-3026-3 Clinical Research

Veterans With Diabetes Receive Arthroplasty More Frequently and at a Younger Age

King, Karen, B., PhD1, 2, a; Findley, Thomas, W., MD, PhD3, 4; Williams, Allison, E., RN, ND, PhD5; Bucknell, Allan, L., MD1, 2
Ankle Elbow Hip Knee Shoulder

Background A future increase in total joint arthroplasties in patients with diabetes seems likely considering the prevalence of osteoarthritis and diabetes mellitus are increasing. However, the rates of arthroplasty in the population of patients with diabetes are unclear.


Questions/purposes We sought to determine whether lower extremity arthroplasties in a veteran population with diabetes is different from a similar population without diabetes. The following specific questions were asked: (1) Is the rate of TKA in veterans with diabetes higher than in those without diabetes? (2) Is the rate of 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?


Methods The US Department of Veterans Affairs Health administrative data from fiscal year 2000 was used to identify persons with primary or secondary TKA or THA. The rate of surgeries among a diabetic population was compared with that among a nondiabetic population.


Results The diabetic cohort received total joint arthroplasties at a higher rate than the nondiabetic cohort at all ages younger than 66 years, with a range of odd ratios from 1.3 to 3.4. In answer to our specific questions, (1) the rate of TKA (95% CI, 2.1-3.7), (2) the rate of THA (95% CI, 1.0-2.6), and (3) the rates of arthroplasty revision (95% CI, 0.9-5.8 TKA and 0.7-6.8 THA) were higher in veterans with diabetes. Furthermore, 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.


Conclusions If these findings hold true for the population as a whole, they imply that clinicians in the United States may see a sharp increase in younger diabetic candidates for joint arthroplasty.


Level of Evidence Level III, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.

Download article