by Joe Holmes PT, DPT, CDN, FNCP


Diabetes has become one of the leading causes of disability and loss of function in the United States. The prevalence of diabetes mellitus (DM 2) is approximately 50% both diagnosed and un-diagnosed (1). Diabetes costs the US healthcare system $327 billion annually and is responsible for $1 in every $7 spent on healthcare (2). Diabetes can speed up the rate at which osteoarthritis progress, which worsens pain and all functional symptoms, and potentially worsens the outcomes of total knee arthroplasties (TKA), also known as a knee replacement (3). Previous studies have associated diabetes with a higher risk of surgical complications, however no meta-analysis has been performed on functional outcomes after a TKA until now.

Results & Discussion

Of the 2,132 studies identified as potentially meeting the inclusion criteria, only 21 met the eligibility criteria to be included. The results were broken down in to preoperative, early postoperative phase (0-12 months post op) and late postoperative phase (1-14 years post op). The overall early and late postoperative findings suggest that people with DM 2 are in worse physical function and have worse quality of life, worse early postoperative pain and strength, and worse late postoperative function, ROM, and QOL than those without DM 2 (3). Many inconsistencies in the studies that were analyzed presented either very low-quality evidence or inconsistent conclusions.


Patients with DM2 have overall increased pain and worse functional outcomes in respect to a TKA compared to patients without diabetes. The overall quality of evidence on this topic is poor and lacks consistent study design. None of the 21 studies included followed by the same rehabilitation protocol post-surgery, which also limits the consistency of the results. The overall message in this article show that overall metabolic health is an important factor in both the development of osteoarthritis and chronic joint pain, and also slows the process of recovery post-surgery.

Physical Therapy First Implications:

The Physical Therapists at Physical Therapy First will create an individualized care plan for you both pre- and post- surgery. All patients at Physical Therapy First receive a 1 hour 1-on-1 appointment at all PT appointments with a doctor of physical therapy. Call today or request an appointment online for any of our 4 locations in Greater Baltimore.


1: Centers for Disease Control and Prevention. Arthritis as a potential barrier to physical activ­ity among adults with diabetes—United States, 2005 and 2007. MMWR Morb Mortal Wkly Rep. 2008;57:486-489


3: Neumann J, Guimaraes JB, Heilmeier U, et al. Diabetics show accelerated progression of knee cartilage and meniscal lesions: data from the Osteoarthritis Initiative. Skeletal Radiol. 2019;48:919-930. s00256-018-3088-0

4: Na A, Opperman LM, Jupiter DC, Lindsey RW, Coronado RA.

Diabetes Mellitus Blunts the Symptoms, Physical Function, and Health- Related Quality of Life Benefits of Total Knee Arthroplasty: A Systematic Review With Meta-analysis of Data From More Than 17 000 Patients  J Orthop Sports Phys Ther 2021;51(6):269-280. Epub 19 Apr 2021. doi:10.2519/jospt.2021.9515