Managing Osteoarthritis in Diabetic Patients: Surgery and Alternatives

Degenerative arthritis

Dr.
Shi's father is 70 years old and has a long-standing history of degenerative arthritis in his left knee, which has resulted in atrophy and deformity.
He underwent a total knee replacement on his right knee 15 years ago.
Due to his current conditions of diabetes and gout, and his fear of unsuccessful surgery leading to inability to walk, he is hesitant to undergo another knee replacement.
I would like to ask Dr.
Shi a few questions:
1.
Is knee replacement surgery suitable for patients with diabetes?
2.
What is the success rate of the surgery considering his age?
3.
How long is the rehabilitation period after the surgery?
4.
If he does not undergo surgery, are there alternative treatment options available?

jason, 30~39 year old female. Ask Date: 2007/09/16

Dr. Shi Guozheng reply Orthopedics

1.
Diabetic patients can undergo surgery as long as their blood sugar is well controlled, typically around 150 or below.

2.
An age of 70 is not considered high; as long as other bodily functions are adequate, the success rate is generally over 90%.

3.
Rehabilitation after surgery typically takes about one to two months.

4.
Without surgery, treatment can only rely on medication, which is primarily for pain relief.

Reply Date: 2007/09/16

More Info

Managing osteoarthritis in diabetic patients, particularly in the context of considering knee replacement surgery, requires a comprehensive understanding of the patient's overall health, the specifics of their diabetes management, and the implications of surgery.
1. Suitability of Knee Replacement Surgery for Diabetic Patients: Diabetes itself is not an absolute contraindication for knee replacement surgery. However, the key factor is how well the diabetes is controlled. Patients with well-managed blood sugar levels can undergo surgery with risks comparable to those of non-diabetic patients. It is crucial to maintain blood glucose levels within a target range (typically below 150 mg/dL) before and after surgery to promote optimal healing and reduce the risk of complications such as infections. In your father's case, if his diabetes is well-controlled, he may be a suitable candidate for the surgery.

2. Success Rate for Older Patients: Age can influence the success rate of knee replacement surgery, but it is not the sole determinant. Generally, older patients can still have successful outcomes, especially if they are in good overall health and have realistic expectations. Studies indicate that patients in their 70s can experience significant pain relief and improved function post-surgery. The success of the surgery also depends on factors such as the severity of osteoarthritis, the presence of other comorbidities (like diabetes and gout), and the patient's adherence to postoperative rehabilitation protocols.

3. Rehabilitation Period: The rehabilitation period after knee replacement surgery typically lasts several weeks to months. Most patients begin physical therapy within a few days post-surgery to regain mobility and strength. The initial recovery phase may take about 6 to 12 weeks, during which patients gradually increase their activity levels. Full recovery, where patients can return to their normal activities, may take up to six months or longer, depending on individual circumstances and adherence to rehabilitation exercises.

4. Alternatives to Surgery: If surgery is deemed too risky or if your father is hesitant, there are several non-surgical alternatives to manage osteoarthritis. These include:
- Physical Therapy: A structured physical therapy program can help strengthen the muscles around the knee, improve flexibility, and reduce pain.

- Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) can help manage pain and inflammation. In some cases, corticosteroid injections into the knee joint may provide temporary relief.

- Weight Management: If your father is overweight, losing weight can significantly reduce stress on the knees and alleviate pain.

- Assistive Devices: Using canes, walkers, or knee braces can help improve mobility and reduce pain during movement.

- Lifestyle Modifications: Engaging in low-impact exercises such as swimming or cycling can help maintain joint function without exacerbating pain.

In conclusion, while your father's age and diabetes present certain challenges, they do not automatically preclude the possibility of knee replacement surgery. A thorough evaluation by an orthopedic surgeon, along with a discussion about the risks and benefits, is essential. If surgery is not pursued, there are various non-invasive strategies to manage his osteoarthritis effectively. It is crucial to work closely with healthcare providers to develop a tailored plan that addresses his specific needs and concerns.

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