Impact of diabetes mellitus and preoperative body mass index on 30-day postoperative complications and readmissions following total knee arthroplasty

Kwong Weng Loh; Suraya Zulkhairi; Khai Hsin Wong; Khairul Anwar Ayob; Veenesh Selvaratnam; Azlina Amir Abbas

doi:10.52312/jdrs.2025.2295

Kwong Weng Loh, Suraya Zulkhairi, Khai Hsin Wong, Khairul Anwar Ayob, Veenesh Selvaratnam, Azlina Amir Abbas

Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia

Keywords: Diabetes mellitus, obesity, postoperative complication, readmission, total knee arthroplasty.

Abstract

Objectives: This study aims to evaluate 30-day postoperative complications and hospital readmissions across different body mass index (BMI) categories and diabetic statuses following primary total knee arthroplasty (TKA).

Patients and methods: Between January 2013 and December 2022, a total of 502 patients (100 males, 402 females; mean age: 68.8±7.7 years; range, 45 to 91 years) who underwent primary TKA for knee osteoarthritis were retrospectively analyzed. Data collected included basic demography, BMI, diabetes mellitus (DM) status, and 30-day postoperative complications such as venous thromboembolism (VTE), infections, neurological events, cardiac events, and renal issues. Readmissions due to operative or medical complications were recorded.

Results: Of the patients, 141 (28.1%) had DM and 186 (37.1%) patients were classified as obese. The obese group experienced the highest incidence of VTE (1.6%), whereas overweight patients exhibited a higher rate of renal events (1.0%). All non-diabetic underweight patients (n=2) developed postoperative hypoglycemia. Diabetic patients had significantly increased odds of VTE compared to non-diabetics (odds ratio=6.74; p=0.009). Normal BMI diabetic patients demonstrated the highest incidence of surgical site infections (7.4%), while normal BMI non-diabetic patients were more prone to foot drop (1.1%) and cardiac events (4.5%).

Conclusion: Elevated BMI and DM independently or in combination, contribute to higher rates of postoperative complications and readmissions following TKA.

Citation: Loh KW, Zulkhairi S, Wong KH, Ayob KA, Selvaratnam V, Abbas AA. Impact of diabetes mellitus and preoperative body mass index on 30-day postoperative complications and readmissions following total knee arthroplasty. Jt Dis Relat Surg 2025;36(3):501-509. doi: 10.52312/jdrs.2025.2295.