Diabetes mellitus, particularly type 2 diabetes, is a widespread disease that affects millions of people worldwide. In addition to the direct effects on blood sugar, diabetes can cause long-term complications such as cardiovascular disease, kidney problems or neuropathic damage. Less known, but equally important, is the increased likelihood of joint problems in diabetics, which often requires joint replacement. But what should you pay attention to when undergoing joint replacement surgery for diabetes patients, and how do the risks and treatment methods differ from those of other patients?

This blog post gives you a comprehensive overview of all important aspects of the topic and provides helpful information for patients.



Why diabetes increases the risk of joint diseases

Diabetic arthropathy: Diabetes can lead to specific joint diseases such as diabetic arthropathy (Charcot joint). This disease occurs particularly when blood sugar is poorly controlled and can severely damage the joint structure.

Inflammatory processes: Chronic elevated blood sugar levels lead to systemic inflammation, which has a negative effect on the cartilage and surrounding tissues. The result is increased joint pain and an increased risk of osteoarthritis.

Impaired healing process: Diabetes reduces the ability of tissues to regenerate, which affects both the course of joint diseases and the chances of postoperative healing.

Risks of joint replacement surgery for diabetes

Infection risks: Diabetes patients are up to three times more likely to develop postoperative infections. This can be explained by a reduced immune system and poorer blood circulation, especially in the lower extremities.

Slowed wound healing: Hyperglycemia can delay wound healing, increasing the risk of wound healing disorders and scarring problems.

Prosthesis loosening: Studies suggest that diabetics are at increased risk of premature prosthesis loosening. Insufficient bone density and impaired bone healing are major contributors.

Cardiovascular complications: The combination of surgery and diabetes increases the risk of heart disease and thrombotic events.

Before the operation: preparation and risk minimization

Optimizing Blood Sugar Control:

• Optimal control of blood sugar levels is crucial to minimize the risk of infection.
• Target value: An HbA1c value of less than 7% is considered optimal before joint replacement surgery.

Preliminary investigations:

• Cardiological evaluation: Diabetes patients often have hidden heart problems, which is why an examination is necessary.
• Vascular status: Doppler ultrasonography to assess blood flow.
• Bone density measurement: To prevent loosening of the prosthesis, the bone quality should be assessed.

Weight management: A high BMI increases the risk of complications. If necessary, a weight loss program should be attempted before the operation.

The operation: special features for diabetes patients

Anesthesia:

• Diabetes patients require specially tailored anesthesia planning because they are at higher risk of cardiovascular complications.

Technical aspects of the procedure:

• Possible use of cement-free prostheses with good bone quality.
• Additional antibacterial coatings on the prosthesis can prevent infections.

Intraoperative blood sugar control: Strict blood sugar management during surgery significantly reduces postoperative complications.

After the operation: special features of aftercare

Blood sugar management: Close monitoring of blood sugar is crucial postoperatively. Hyper- and hypoglycemia should be consistently avoided.

Rehabilitation:

• Individually tailored rehabilitation programs take reduced resilience and possible complications such as diabetic foot syndrome into account.
• Water-based therapies (hydrotherapy) have proven to be a gentle method.

Infection prevention:

• Strict hygiene when treating wounds.
• Long-term administration of low-dose antibiotics with a high risk of infection.

Physiotherapy: Gentle mobilization is particularly important to ensure the functionality of the prosthesis without endangering healing.

Conclusion: Joint replacement for diabetes – a success with good preparation

Joint replacement operations for diabetes patients are complex, but with the right preparation and aftercare they offer excellent opportunities for a significant improvement in quality of life. Close collaboration between your family doctor, the surgeon and, if necessary, a rehabilitation specialist is the key to success.