Large numbers of orthopaedic operations are carried out on patients with diabetes. In a patient with diabetes there is an increased risk of complications from the diabetes around the time of the surgery and there is an increased risk of infection following surgery. If the patient is fully prepared and the diabetes is under the best possible control then the extra risk is quite small and surgery can normally be carried out without difficulty.
In all patients with diabetes we suggest that you see your GP or diabetic specialist for a check before you come in for surgery. In our preoperative assessment clinic we will check your blood sugar and other blood tests. If these are not satisfactory we will suggest that you see your GP or diabetic specialist to adjust the treatment.
In a patient with type II diabetes, which is normally controlled by diet or tablets, You should continue to take your normal tablets and pay particular attention to your diet regime in the weeks prior to surgery to get the best possible stable control of the blood sugar. You will be asked not to take your tablets immediately prior to the surgery. This is in case your blood sugar falls excessively during the operation. After the surgery you take your tablets normally. Sometimes it is necessary for a patient with type II diabetes to need insulin after surgery but this is quite unusual.
In a patient with type I diabetes, controlled by insulin, we have protocols for the use of the insulin around the time of surgery which have been worked out between diabetic specialists and our anaesthetists.
It is difficult to be precise about the extra risk of infection after orthopaedic surgery in patients with diabetes. In a patient undergoing a total hip replacement the risk of infection is probably less than one patient in 100. In patients with diabetes the risk is probably around double, probably it is around one in 70. The risk is probably increased if the diabetes is poorly controlled and also if there are other factors, such as smoking.
As most patients with diabetes are aware there are particular problems with the circulation and the feet in diabetes. A lot of further surgery is carried out on patients with diabetes who have bunions and similar disorders. Most of the time the surgery goes without any difficulty at all but there is a small risk of infection and other serious complications in foot surgery carried out on patients with diabetes.