Diabetes Mellitus Blunts the Symptoms, Physical Function, and Health-Related Quality of Life Benefits of Total Knee Arthroplasty: A Systematic Review With Meta-Analysis of Data From More Than 17,000 Patients.

Abstract

OBJECTIVE\nTo compare physical function, pain, impairments (stiffness, range of motion, and strength), and health-related quality of life (HRQOL) outcomes between patients with and without diabetes mellitus, before and after a total knee arthroplasty (TKA).\n\n\nDESIGN\nPrognosis systematic review.\n\n\nLITERATURE SEARCH\nWe searched MEDLINE/PubMed, CINAHL, PsycINFO, and Web of Science to August 2019.\n\n\nSTUDY SELECTION CRITERIA\nWe included longitudinal studies that examined physical function, pain, impairments and HRQOL outcomes among patients receiving a TKA and with or without diabetes.\n\n\nDATA SYNTHESIS\nFor quantitative synthesis, we stratified outcomes based on time relative to TKA: pre-operative, up to 1-year after a TKA (early post-operative), and 1-year or more after TKA (late post-operative). We used random-effects meta-analysis to calculate standardized mean differences (SMD) with 95% confidence intervals. We used the Grading of Recommendation Assessment, Development and Evaluation (GRADE) system for qualitative synthesis.\n\n\nRESULTS\nWe included 21 studies (N = 17,472 patients). Patients with diabetes mellitus had worse pre-operative physical function (SMD, -0.16; 95% CI, -0.26 to -0.05) and HRQOL (SMD, -0.16; 95% CI, -0.26 to -0.05), worse early post-operative pain (SMD, -0.22; 95% CI, -0.39 to -0.05) and strength (SMD, -0.45; 95% CI, -0.77 to -0.14), and worse late post-operative physical function (SMD,-0.23; 95% CI, -0.40 to -0.06), ROM (SMD, -0.23; 95% CI, -0.455 to -.003), and HRQOL (SMD, -0.19; 95% CI, -0.29 to -0.08) than patients without diabetes mellitus. The overall risk of bias across studies was high and the certainty of evidence ranged from low to very low.\n\n\nCONCLUSION\nPatients with diabetes mellitus had worse patient-reported and clinician-assessed outcomes before and after TKA. Given the limitations of included studies, these results may change with future research. J Orthop Sports Phys Ther, Epub 19 Apr 2021. doi:10.2519/jospt.2021.9515.