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Table 1 Summary of studies identifying knee stiffness after total knee arthroplasty in populations with diabetes mellitus

From: Diabetes mellitus does not increase the risk of knee stiffness after total knee arthroplasty: a meta-analysis of 7 studies including 246 053 cases

Study Population Aim Definition of stiffness Study design Conclusion Number Prevalence
Cartwright-Terry et al. [18] 2018 UK To assess the functional outcome of manipulation in patients after knee replacement and to investigate potential predictive factors for stiffness MUA required postoperatively. Decision based on symptoms, functional requirements, and clinical examination. No formal degree of flexion was used Nested case–control Patients with DM more likely to require manipulation 138 TKAs
Stiff group:
Total number = 69
Number of DM = 10
Control group:
Total number = 69
Number of DM = 3
Percentage of stiff group with DM = 14%
Percentage of control group with DM = 4%
Clement et al. [17] 2018 UK The primary aim was to compare the outcome (WOMAC, Short form (SF)-12, and satisfaction) of patients with increased symptoms of stiffness 1 year after TKA with those who had no change or improvement in symptoms. The secondary aim was to identify independent predictors of increased symptoms of stiffness 1 year after TKA Patients who had a worse or negative (1 year after TKA compared to preoperatively) change in the WOMAC stiffness score were defined as the increased symptoms of stiffness group. This group was compared to those who had no change or improved symptoms at 1 year Retrospective cohort DM significantly predictive of increased stiffness 1 year after surgery 2589 TKAs
Stiff group:
Total number = 129
Number of DM = 27
Control group:
Total number = 2460
Number of DM = 338
Percentage of stiff group with DM = 20.9%
Percentage of control group with DM = 13.7%
Dowdle et al. [19] 2018 USA To determine the incidence of MUA after revision TKA, to better define the modifiable and non-modifiable postoperative risk factors associated with postoperative stiffness after revision TKA, and to determine the timing of MUA for postoperative stiffness MUA performed postoperatively Case-control DM did not increase the risk of MUA after revision TKA 5414 TKAs
Stiff group:
Total number = 96
Number of DM = 41
Control group:
Total number = 5318
Number of DM = 2181
Percentage of stiff group with DM = 42.7%
Percentage of control group with DM = 41%
Issa et al. [8] 2015 USA To evaluate the effect of various (1) demographic factors, (2) comorbidities, and (3) knee-specific factors on the frequency of MUA, which was used as an indicator of knee stiffness after a primary TKA Need for MUA and < 110° of ROM at 6 weeks after TKA with no recent gains after physical therapy Case-control DM was associated with an increase in frequency of MUA after TKA 3182 TKAs Odds ratio of DM to non-DM having to have MUA: 1.72 (1.02–2.31), p = 0.0311.
Pfefferle et al. [16] 2014 USA To test the null hypothesis that there is no increased rate of postoperative stiffness requiring an MUA within 90 days of a TKA between groups stratified by race, gender, nicotine dependence, depressive disorder, obesity (BMI N30), DM, opioid abuse/dependence, rheumatoid arthritis, and age at time of TKA MUA within 90 days of TKA
No definition of indication for MUA specified
Case-control DM was not a significant risk factor for postoperative knee stiffness requiring MUA after TKA 229,420 TKAs
Stiff group:
Total number = 3470
Number of DM = 1050
Control group:
Total number = 225,950
Number of DM = 70,280
Percentage of stiff group with DM = 30.2%
Percentage of control group with DM = 31.1%
Gandhi et al. [4] 2006. Canada To identify the incidence of and predictive factors associated with knee flexion less than 90° at 1 year after TKA One year postoperative flexion less than 90° Case-control No correlation between postoperative stiffness and specific medical comorbidities, including DM 90 TKAs
Stiff group:
Total number = 45
Number of DM = 8
Control group:
Total number = 45
Number of DM = 3
Percentage of stiff group with DM = 17.8%
Percentage of control group with DM = 6.7%
Meding et al. [12] 2003 USA To review the results of TKR in DM patients and to test the hypothesis DM patients achieve inferior results after TKR MUA required postoperatively. No time or indication specified Case-control DM not associated with an increased rate of manipulation rate after TKA. Insulin-dependent diabetics more susceptible to manipulation than noninsulin-dependent diabetic patients 5220 TKAs
Stiff group:
Total number = 65
Number of DM = 4
Control group:
Total number = 5155
Number of DM = 325
Percentage of stiff group with DM = 6.1%
Percentage of control group with DM = 6.3%