What is the association between insulin dependence and the incidence of postoperative complications, perioperative glucose control, and five-year reoperation rates after total joint replacement?
- Design
- Retrospective cohort · 830 participants · Intermediate outcome
- Match to healthy normal-weight adults aged 55–75
- Population unclear[Auto] Population characteristics not extractable from abstract (age/BMI not reported in abstract). Needs manual review.
- Could weight loss explain it?
- Unknown[Auto] Not addressed in abstract.
- Study tier
- Study tier 3[Auto] Observational design; confounding by indication and healthy-user effects cannot be excluded (auto-provisional).
- Assessment
- Version 1 · automatic, not yet reviewed by a person · Sep 13, 2026
Study facts come from the paper. Population match, weight-loss explanation and study tier are our judgments, made against the reference group of healthy normal-weight adults aged 55–75.
[Auto, unreviewed; quoted from abstract conclusions] Insulin dependence is an independent risk factor for 90-day complications and poorer perioperative glucose control, but not reoperation, following primary THA and TKA. These findings suggest insulin dependence is a clinically meaningful risk marker beyond glycaemic indices. Further investigation into optimization strategies to mitigate this perioperative risk is warranted.
01Findings
What the study reported
- Drugs
- Class unspecified
- Primary outcome
- Not extracted
- Effect
- Not extracted
- 95% confidence interval
- Not extracted
- Follow-up
- Not stated
- Adverse events
- Not extracted
- Limitations
- Auto-classified from abstract only; effect estimates, adverse events and limitations not extracted. Requires manual review.
Who was studied
- Diabetes status
- diabetes mentioned
- Sample size
- 830
Study quality details
- Study design
- Retrospective cohort
- Sample size
- 830
- Randomization
- no
- Blinding
- not stated
- Comparator
- not stated
- Follow up duration
- not stated
- Outcome type
- intermediate
- Replication
- not assessed (auto)
- Consistency with other evidence
- not assessed (auto)
- Population applicability
- UNKNOWN
- Statistical precision
- CI reported: 95% CI 1
- Risk of bias
- not assessed (auto)
- Funding conflicts
- unclear
- Peer review status
- yes
02Funding
Funding and conflicts
- Funding
- not reported in abstract
- Industry funded
- Unclear
- Manufacturer
- None identified
- Sponsor role
- not reported in abstract
- Author conflicts
- B. Ricciardi reports grants or contracts from the National Institutes of Health, Trellis Biosciences, and Johnson & Johnson; and payment or honoraria for lectures, presentations, speakers' bureaus, manuscript writing, or educational events from the American Board of Orthopaedic Surgery. C. Thirukumaran discloses grants or contracts, paid to the institution, from the National Institutes of Health; consulting fees from Columbia University; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from the National Institutes of Health, Brigham and Women’s Hospital, and the Orthopaedic Research Society (ORS); and being section editor for Current Osteoporosis Reports and research chair for the ORS.
- Independent replication
- unknown
Funding is shown on every study and never used to score it.
04Source
The source, as retrieved
Abstract
[AIMS] Diabetes mellitus (DM) is associated with adverse outcomes following total hip arthroplasty (THA) and total knee arthroplasty (TKA), yet optimal perioperative risk stratification remains unclear. This study evaluated the association of insulin dependence with: 1) 90-day complications; 2) perioperative glucose control; and 3) mid-term reoperations in diabetic patients undergoing primary THA and TKA. [METHODS] We performed a retrospective, single-centre study of patients with DM undergoing primary THA or TKA between 2015 and 2022. Patients with preoperative glycated haemoglobin (HbA1c) ≥ 6.5 were categorized as insulin-dependent DM (IDDM) or insulin-independent DM (NIDDM). Demographic and clinical variables including preoperative haemoglobin A1C and oral DM medication usage were recorded. The primary outcome was 90-day complications. Secondary outcomes included mean and maximum perioperative glucose levels and reoperations. Multivariable logistic and linear regression analyses were used to evaluate association between insulin dependence and outcomes while adjusting for relevant confounders. [RESULTS] A total of 830 patients were included: 351 (42.3%) with IDDM and 479 (57.7%) with NIDDM. Overall, 90-day complications were more common in the IDDM cohort (35.9% vs 16.3%, p < 0.01). Insulin dependence was associated with increased odds of 90-day complications (odds ratio 2.81, 95% CI 1.98 to 3.98). Male sex, metformin use, and glucagon-like peptide-1 receptor agonist use were associated with lower complication risk. Preoperative HbA1c was not independently associated with complications. Insulin dependence and preoperative haemoglobin A1C were associated with worse perioperative glucose control. Reoperation rates were similar between groups. [CONCLUSION] Insulin dependence is an independent risk factor for 90-day complications and poorer perioperative glucose control, but not reoperation, following primary THA and TKA. These findings suggest insulin dependence is a clinically meaningful risk marker beyond glycaemic indices. Further investigation into optimization strategies to mitigate this perioperative risk is warranted.
Where this record came from
| Source | Retrieved | Identifier |
|---|---|---|
| pubmed | Sep 13, 2026 | 42686200 first ingestion |