Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Apr 18, 2015; 6(3): 331-339
Published online Apr 18, 2015. doi: 10.5312/wjo.v6.i3.331
Diabetes and its negative impact on outcomes in orthopaedic surgery
Dane K Wukich
Dane K Wukich, Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, UPMC Mercy Health Center, Pittsburgh, PA 15219, United States
Author contributions: Wukich DK personally wrote and researched the entire manuscript.
Conflict-of-interest: The author acknowledges that he is a consultant for Stryker and receives royalties from Arthrex.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Dane K Wukich, MD, Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, UPMC Mercy Health Center, 1515 Locust St Suite 325, Pittsburgh, PA 15219, United States.
Telephone: +1-412-2329080 Fax: +1-412-2329088
Received: June 29, 2014
Peer-review started: June 30, 2014
First decision: August 14, 2014
Revised: February 6, 2015
Accepted: February 9, 2015
Article in press: February 11, 2015
Published online: April 18, 2015

An estimated 285 million adults (aged 20-79 years) worldwide were diagnosed to have diabetes mellitus (DM) in 2010, and this number is projected to grow to 439 million adults by the year 2030. Orthopaedic surgeons, regardless of their subspecialty interest, will encounter patients with DM during their career since this epidemic involves both developed and emerging countries. Diabetes results in complications affecting multiple organ systems, potentially resulting in adverse outcomes after orthopaedic surgery. The purpose of this review is to discuss the pathophysiology of DM and its potential for impacting orthopaedic surgery patients. Diabetes adversely affects the outcome of all orthopaedic surgery subspecialties including foot and ankle, upper extremity, adult reconstructive, pediatrics, spine surgery and sports medicine. Poorly controlled diabetes negatively impacts bone, soft tissue, ligament and tendon healing. It is the complications of diabetes such as neuropathy, peripheral artery disease, and end stage renal disease which contributes to adverse outcomes. Well controlled diabetic patients without comorbidities have similar outcomes to patients without diabetes. Orthopaedic surgeons should utilize consultants who will assist in inpatient glycemic management as well as optimizing long term glycemic control.

Keywords: Diabetes, Orthopaedic surgery, Outcomes, Complications, Neuropathy

Core tip: Diabetes is associated with adverse outcomes following orthopaedic surgery. The complications of diabetes such as poor glycemic control, neuropathy, end stage renal disease and neuropathy contribute to adverse outcomes. These adverse outcomes include surgical site infections, impaired wound healing, pseudarthrosis, hardware and implant failure and medical complications. Patients with diabetes who undergo orthopaedic surgery should receive optimal medical management prior to elective surgery in order to minimize complications.