JOA - 2026-08-24 - Journal Article
Diabetes is Associated with an Increased Risk of Arthrofibrosis Following Total Knee Arthroplasty.
Hall RP, Braithwaite CL, Van Schuyver PR, Verhey JT, Lebens R, Deckey DG, Christopher ZK, Bingham JS
Topics
Key Takeaway
Preoperative HbA1c ≥8.0 confers nearly double the odds of arthrofibrosis requiring MUA or aLOA within 3 months of TKA compared to non-diabetic controls (OR 1.91, 95% CI 1.35–2.71), with risk increasing in a dose-dependent fashion across glycemic strata.
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Summary
This retrospective database study examined whether preoperative HbA1c level predicts arthrofibrosis requiring MUA or aLOA after primary TKA, stratifying patients into four glycemic groups and using propensity score matching. All three diabetic strata showed significantly elevated odds of early arthrofibrosis (<3 months): OR 1.21 for HbA1c 5.7–6.9, OR 1.65 for 7.0–7.9, and OR 1.91 for ≥8.0 versus non-diabetic controls. No significant differences were detected at 3–12 months in any group, and the ≥8.0 cohort had suppressed event counts beyond 12 months, limiting late-interval analysis.
Key Limitation
Suppressed event counts in the HbA1c ≥8.0 group beyond 12 months preclude assessment of late arthrofibrosis risk in the highest-risk cohort, and total sample sizes are not disclosed, preventing power assessment.
Original Abstract
INTRODUCTION
The relationship between diabetes and arthrofibrosis following total knee arthroplasty (TKA) remains unclear. This study evaluated whether varying levels of preoperative glycemic control, measured by hemoglobin A1c (HbA1c), are associated with arthrofibrosis requiring manipulation under anesthesia (MUA) or arthroscopic lysis of adhesions (aLOA) after TKA.
METHODS
A retrospective cohort analysis of a healthcare database identified patients who underwent primary TKA between 2006 and 2026. Patients were stratified by preoperative HbA1c: well-controlled (5.7 to 6.9), moderately uncontrolled (7.0 to 7.9), severely uncontrolled (≥ 8.0), and non-diabetic controls (less than 5.7). Propensity score-matched cohorts were assessed for MUA or aLOA rates at less than three months, three to 12 months, and greater than 12 months postoperatively.
RESULTS
Compared with controls, patients who had HbA1c 5.7 to 6.9 had increased odds of MUA or aLOA within three months after TKA (odds ratio (OR) 1.21, 95% confidence interval (CI) 1.07 to 1.37), with no significant differences at three to 12 months or greater than 12 months. Patients who had HbA1c 7.0 to 7.9 demonstrated greater early risk within three months (OR 1.65, 95% CI 1.37 to 1.97), without significant differences at later time points. Patients who had HbA1c ≥ 8.0 demonstrated the highest early risk within three months (OR 1.91, 95% CI 1.35 to 2.71), with no significant difference at three to 12 months; analysis beyond 12 months was limited by suppressed event counts.
CONCLUSION
Diabetes is associated with an increased risk of arthrofibrosis requiring MUA or aLOA within three months following TKA. Increasing HbA1c levels correlated with progressively higher early arthrofibrosis risk. These findings suggest that worse preoperative glycemic control is associated with an elevated risk of early postoperative arthrofibrosis following TKA.