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Home > Having a Knee Replacement as a Diabetic – What you Need to Know

Having a Knee Replacement as a Diabetic – What you Need to Know


Dr. John BurrowJohn D. Burrow, DO

Americans are living longer and as a result are demanding a higher quality of life as they age.  That means they are having to contend with some of the illness and conditions often associated with aging while at the same time trying to maintain, repair or replace the body parts that are wearing out.  It can be a conundrum. 

As a busy Orthopaedic surgeon, one of those accompanying conditions or comorbidities I often see in my practice is Diabetes.  I don’t treat diabetes, but I do have to help my patients understand the impact that it can have on any orthopaedic surgery and especially a knee replacement.  In this article, I hope to give you the answers you need if you are a diabetic and you are considering this procedure.

Can diabetics have their knees replaced safely and have great outcomes?  Absolutely!  I believe that proper patient education and appropriate expectation setting are important.  For any of my diabetic patients, I want their diabetes to be well controlled before surgery.  However, I am a realist and know that many diabetics struggle with glycemic control.  A visit to the PCP and/or the Endocrinologist may be in order, to jumpstart proper control through nutrition, insulin management, exercise, and weight loss, if needed.  

Most Anesthesiologists request that diabetic present with an A1C level of 7.5 or lower before going into surgery.  The A1C test measures the percentage of red blood cells that have sugar-encased hemoglobin.  While everyone has some, those with diabetes have more, which can be problematic during anesthesia, increase complications during surgery and for healing after surgery. Most physicians consider a normal A1C to be in the range of 7 -7.5 for a diabetic, so patients are given a bit of wiggle room. 

So, what if you are my patient and no matter how hard you try, with diet, exercise and medication, you can’t get your A1C to the recommended level for knee replacement surgery?  You and I will discuss the risks and benefits so that you are fully informed about both.  Diabetics are at increased risk for bone healing complications, surgical site infections and slower healing times, even when their condition is well-managed.  Our goal is a knee that allows you to walk and move freely, which is important as well to your quality of life.  You must weigh all factors carefully.

If you decide to move forward with your knee replacement, I may decide to keep you in the hospital overnight, instead of performing your procedure as an outpatient surgery.  Because diabetics are at increased risk for post-surgical infection, we may pay special attention to post-surgical wound care with in-home nursing.  You can rest assured that I will provide the best care for you after your knee replacement so that you have a great recovery and outcome, even with diabetes.

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