Risks
- Higher rates of periprosthetic joint infection, wound complications and VTE
- Poor glycaemic control raises infection risk more than diabetes itself
- Neuropathy, renal disease and cardiovascular disease raise perioperative risk
- Functional outcomes are similar to patients without diabetes
- Diabetes affects about 1 in 10 patients having hip arthroplasty
- Infection risk rises with perioperative glucose above about 11 mmol/L
- Peripheral vascular disease and obesity often coexist
- Charcot arthropathy of the hip is rare but should be considered
Preoperative Optimisation
- Measure HbA1c. Many units defer elective arthroplasty when HbA1c is above about 8%
- Screen for renal function, cardiac disease and foot ulcers
- Withhold SGLT2 inhibitors before surgery as per ADS and ANZCA guidance to avoid euglycaemic ketoacidosis
- Review oral agents and insulin with the anaesthetist and endocrine team
- Check for undiagnosed diabetes with HbA1c in at risk patients
- Optimise weight, smoking and nutrition at the same time
Perioperative Care
- Keep glucose below about 10 mmol/L
- Dexamethasone for nausea raises glucose
- Endocrine input for insulin regimens
- See Periprosthetic Infections
- Place diabetic patients first on the list to shorten fasting
- Monitor glucose regularly while fasting and after surgery
- Resume oral agents once eating normally
- Inspect the heels and feet daily to avoid pressure ulcers
- Delayed wound healing needs closer wound review
Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.