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