Diabetes mellitus, particularly type 2 diabetes, is a widespread disease affecting millions of people worldwide. Besides its direct impact on blood sugar levels, diabetes can cause long-term complications such as cardiovascular disease, kidney problems, and neuropathic damage. Less well-known, but equally significant, is the increased likelihood of joint problems in diabetics, often necessitating joint replacement surgery. But what must be considered during joint replacement surgery for diabetic 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 offers 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 condition occurs particularly when blood sugar is poorly controlled and can severely damage the joint structure.

Inflammatory processes: Chronically elevated blood sugar levels lead to systemic inflammation, which negatively affects cartilage and surrounding tissues. This results in increased joint pain and a higher risk of osteoarthritis.

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

Risks of joint replacement surgery in diabetes

Infection risks: Diabetic patients have up to three times the risk of developing 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 impaired wound healing and scarring problems.

Prosthesis loosening: Studies suggest that diabetics have an increased risk of premature prosthesis loosening. Insufficient bone density and impaired bone healing contribute significantly to this.

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:

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

Preliminary investigations:

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

Weight management: A high BMI increases the risk of complications. A weight loss program should be considered before surgery.

The operation: Special considerations for diabetic patients

Anesthesia:

• Patients with diabetes require specially adapted anesthesia planning because they have a higher risk of cardiovascular complications.

Technical aspects of the intervention:

• Possible use of cementless prostheses in cases of good bone quality.
• Additional antibacterial coatings on the prosthesis can prevent infections.

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

After the operation: Special considerations for aftercare

Blood glucose management: Close monitoring of blood glucose levels is crucial postoperatively. Hyperglycemia and hypoglycemia should be consistently avoided.

Rehabilitation:

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

Infection prevention:

• Strict hygiene during wound care.
• Long-term administration of low-dose antibiotics in cases of high risk of infection.

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

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

Joint replacement surgery for diabetic patients is complex, but with proper preparation and aftercare, it offers excellent chances of a significant improvement in quality of life. Close collaboration between your family doctor, the surgeon, and, if necessary, a rehabilitation specialist is key to success.