Abstract
BACKGROUND: Diabetic Neuropathy and other neurological disorders impact surgical outcomes in total joint arthroplasty (TJA). While Diabetes has been extensively studied, limited research addresses the specific effect of Diabetic Neuropathy on postoperative outcomes. This study evaluates complication rates among patients with Neuropathy, Diabetes, or both undergoing primary TJA. METHODS: A retrospective analysis was conducted on 2600 patients who underwent unilateral primary total knee or hip arthroplasty at a single high-volume institution between 2001 and 2023. Patients were stratified into four cohorts: Neuropathy with Diabetes (N = 655), Neuropathy without Diabetes (N = 675), Diabetes without Neuropathy (N = 707), and other neurological disorders (N = 563). The primary outcome was 90-day postoperative medical complications. Secondary outcomes included 90-day orthopaedic complications (infection, wound issues, fracture), 90-day all-cause readmission, early revision (<2 years), and non-home discharge. Statistical analysis utilized bivariate comparisons, including ANOVA, Kruskal-Wallis, and Chi-square testing. Pairwise comparisons were performed when appropriate. RESULTS: Patients with both Neuropathy and Diabetes had the highest 90-day complication rate (35.1%) compared with Diabetes without Neuropathy (23.1%), Neuropathy without diabetes (16.2%), and other neurological disorders (12.7%). Readmission was highest in the Neuropathy with Diabetes group (8.24%) versus Neuropathy without Diabetes (5.63%), Diabetes without Neuropathy (6.65%), and other neurological disorders (3.91%). Surgical site infections occurred more often in Neuropathy with Diabetes (2.75%) than in other groups (≤0.85%). Non-home discharge was most common among Diabetes without Neuropathy patients (38.5%). CONCLUSION: Diabetic Neuropathy is associated with higher rates of postoperative complications, readmissions, and infections following TJA. These patients represent a high-risk group requiring focused preoperative optimization and postoperative care to improve outcomes.