Understanding Orthopedic and Surgical Issues for People with Diabetes

Throughout our blog series, we have emphasized the importance of managing diabetes health or prevention to lower the risk of a wide range of diseases and conditions, including heart disease, kidney and liver failure, and Alzheimer's.

Another factor that patients with diabetes have to be concerned about is the complications they confront when they experience an orthopedic injury. Studies have shown that the healing of fractures in diabetic patients is prolonged by 87%, and the risk of complications including re-dislocation is almost three and a half times higher![i]

iStock-821012456 man suffering from knee painWhile the exact cause has yet to be pinpointed, people with diabetes are very likely to develop bone and joint disorders. I would bet my house that nerve damage, arterial disease, and obesity from poorly controlled diabetes are contributing factors. Here are some specific disorders that support my conviction:

  • Neuropathic arthropathy, also known as Charcot joint, is a condition in which a joint deteriorates due to nerve damage in the affected area. It is a common predicament among people with diabetes.
  • People with type 2 are at a high risk of osteoarthritis, a crackup of joint cartilage, likely caused by obesity. Osteoarthritis can result in a loss of joint flexibility or even movement, along with pain and stiffness of the joint.
  • People with type 1 have a high risk of osteoporosis, a disorder that weakens bones, making them more sustainable to fracture. There are no early warning signs for osteoporosis, so proactive diabetes care management is perhaps your only form of prevention.[ii]

There are quite a few other debilitating orthopedic conditions with strong associations to diabetes, and just like every other collaborative side effect, the best defense is a proper diet and regular exercise routine. More specifically, consulting with your care management team to make sure you are including sufficient amounts of calcium and vitamin D to your meal planning is also an excellent first step.

The double whammy here is that – in addition to your bones and joints being more susceptible to injury – the adverse side effects of diabetes (such as limited mobility from obesity and nerve damage, as well as loss of vision – also from nerve damage) are more likely to cause injuries from loss of balance and or falling.

iStock-519543788 surgery toolsIf surgery is required for an orthopedic injury, there are even greater complications (in addition to the cost) for patients with diabetes.

  • Orthopedic surgeons will not operate if the hemoglobin A1c levels are too high, thus prolonging the injury and subsequent pain.
  • High or low glucose levels during surgery can result in a host of post-surgical complications, including hypoglycemia. 
  • There is a glossary of additional post-surgery concerns of a serious nature. The physical and mental stress of surgery can cause undesirable changes in hormone levels that can lead to insulin resistance and hence, increase the risk for hyperglycemia, dehydration, impaired wound healing, infection, diabetic ketoacidosis (DKA), or hyperglycemic hyperosmolar syndrome (HHS, a condition in which the patient has high glucose levels, dehydration and decreased levels of consciousness).[iii] 
  • The worst case scenario is when a person with diabetes needs a total knee, or hip replacement surgery, or a spinal procedure. For these types of surgeries, a certain amount of osseointegration is required (i.e., the direct structural and functional connection between living bone and the surface of a load-bearing artificial implant). The impact of diabetes on bone health reduces the level of bone-implant contact, thus inhibiting effective osseointegration. Therefore, if the body does not accept the "hardware," you will have a failed implant, often infections, and other postoperative issues that are miserable for the patient. If a patient has any of these postoperative problems, the hospital and the surgeon will be on the financial hook for a patient's recovery because Medicare and most private insurance will not reimburse for postoperative complications. This explains why surgeons will refuse to treat patients with even moderately high A1c levels – the risk is too high.

Diabetes is even more of an obstacle when it comes to dental implant osseointegration.[iv] Good glycemic control, pre- and postoperative, is required to achieve improved osseointegration, but there are no guarantees if the patient has let their diabetes go unchecked or under-managed over a long period.

As a consequence, doctors have to be very selective as to whom they can help when it comes to diabetes. This "too little, too late" scenario explains why almost 70 percent of limb amputations are attributable to diabetes-related complications.[v] 

Hopefully, this blog has opened your eyes one more time to the significant challenges that face people who do not adequately manage their diabetes. 

Learn More About Autonomic Neuropathy

[i] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4692363/
[ii] https://www.mayoclinic.org/diseases-conditions/diabetes/in-depth/diabetes/art-20049314
[iii] https://www.verywellhealth.com/diabetes-and-surgery-post-op-concerns-1087723
[iv] http://biomedpharmajournal.org/vol8octoberspledition/effect-of-diabetes-in-osseointegration-of-dental-implant-a-review/
[v] https://www.thediabetescouncil.com/diabetes-and-amputation-everything-you-need-to-know-to-avoid-amputation/

Sean Browne

Sean Browne

Former Chief Revenue Officer, CCS Medical

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