Abstract

Endoprosthesis of joints of the lower, limb Hip and Knee Arthroplasty (HKA) are common surgical interventions that require balanced volemic support and infusion therapy (IT), especially in patients with concomitant diabetes mellitus (DM).
The aim: to determine the effectiveness of balanced volemic support in the perioperative period for HKA in patients with diabetes.

Materials and methods. A retrospective analysis of the inpatient charts of 50 patients who underwent HKA operations against the background of concomitant DM was performed. All patients were divided into two groups: 1) patients with hip arthroplasty, 2) patients with knee arthroplasty. The course of the perioperative period, the need for infusion support, and the development of complications were analyzed.

The results. All patients were aged from 38 to 86 years, had increased weight (BMI – 26.0-29.4 kg/m2). There were no differences in general and anthropometric indicators between patients of the groups (p>0.05). IT was performed in all 50 patients (100.0 %) and consisted of crystalloids and polyionic drugs based on polyatomic alcohols and organic anions. Clinical and anamnestic data, the course of the perioperative period and the development of complications were of the same type in patients regardless of the location of the intervention (p>0.05).

Conclusions. The infusion therapy program during HKA operations should include simple and balanced solutions of crystalloids and polyionic preparations based on polyatomic alcohols and organic anions. Colloidal solutions and blood preparations should not be included in the infusion program, except in cases of special indications. The use of such a program helps to reduce the number of perioperative complications and carbohydrate metabolism disorders.

Key words: hip joint replacement, knee joint replacement, infusion therapy, diabetes

1. Weber M, Völlner F, Benditz A, et al. Kniegelenkersatz des älteren Menschen [Total knee arthroplasty in the elderly]. Orthopade. 2017 Jan;46(1):34-39. German. doi: 10.1007/ s00132-016-3363-5. PMID: 27921128.
2. Roger C, Debuyzer E, Dehl M, et al. Factors associated with hospital stay length, discharge destination, and 30-day readmission rate after primary hip or knee arthroplasty: Retrospective Cohort Study. Orthop Traumatol Surg Res. 2019 Sep;105(5):949-955. doi: 10.1016/j.otsr.2019.04.012. Epub 2019 Jun 15. PMID: 31208932.
3. Rudy MD, Ahuja NK, Aaronson AJ. Diabetes and Hyperglycemia in Lower-Extremity Total Joint Arthroplasty: Clinical Epidemiology, Outcomes, and Management. JBJS Rev. 2018 May;6(5):e10. doi: 10.2106/JBJS.RVW.17.00146. PMID: 29847443.
4. Ren X, Ling L, Qi L, et al. Patients’ risk factors for periprosthetic joint infection in primary total hip arthroplasty: a meta-analysis of 40 studies. BMC Musculoskelet Disord. 2021 Sep 12;22(1):776. doi: 10.1186/s12891-021-04647-1.
5. Maradit Kremers H, Lewallen LW, Mabry TM, et al. Diabetes mellitus, hyperglycemia, hemoglobin A1C and the risk of prosthetic joint infections in total hip and knee arthroplasty. J Arthroplasty. 2015 Mar;30(3):439-43. doi: 10.1016/j. arth.2014.10.009. Epub 2014 Oct 15. PMID: 25458090.
6. Deng W, Huo L, Yuan Q, et al. Risk factors for venous thromboembolism in patients with diabetes undergoing joint arthroplasty. BMC Musculoskelet Disord. 2021 Jul 6;22(1):608. doi: 10.1186/s12891-021-04453-9.
7. Loskutov O.A., Bondar M.V., Todurov B.M., Humenyuk M.I., Halushko O.A., Markov YU.I., Kuchyns’ka I.A. Otsinka peredoperatsiynoho statusu patsiyenta i pidhotovka do khirurhichnoho vtruchannya [Assessment of the patient’s preoperative status and preparation for surgery]. Kyiv, 2019. 228 p.
8. Qin W, Huang X, Yang H, Shen M. The Influence of Diabetes Mellitus on Patients Undergoing Primary Total Lower Extremity Arthroplasty: A Systematic Review and Meta-Analysis. Biomed Res Int. 2020 Dec 15;2020:6661691. doi: 10.1155/2020/6661691. PMID: 33490250; PMCID: PMC7787736.
9. Netyazhenko V.Z., Halushko O.A. Neintensyvna infuziyna terapiya v praktytsi likarya vnutrishn’oyi medytsyny [Non- intensive infusion therapy in the practice of a doctor of internal medicine]. Ukrainian Chemotherapy Journal, 2012, 3(26): 164-169.