Over the course of the present study, CHIR-99021 the three groups had considerably lower health status, as seen with lower HUI3 scores when compared to the general community-dwelling population with diabetes without comorbidities (0.88), those with one comorbidity (0.77 to 0.79), and those with two comorbidities (0.64 to 0.66).37 To our knowledge, this is the first study to show that the severity of diabetes, as indicated by its perceived impact on function, was predictive of recovery after TKA. While most studies have defined diabetes as a dichotomous variable or in terms of glycemic control, asking participants to report the impact of a condition on routine

activities provides insight into the functional impact of the condition. This has direct implications for physiotherapists in their assessment of people undergoing TKA. Although the severity of diabetes has been evaluated in terms

of glycemic control in people with total joint arthroplasty,5 it was found that admission fasting blood glucose levels were not significant in explaining MK-2206 in vivo the 6-month trajectories for pain and function. Glycemic control was predictive of complications, mortality, increased length of stay, and higher hospital charges after total joint arthroplasty in a large patient sample.5 Others have not evaluated the severity of the diabetes, but rather evaluated chronic conditions as a simple count to capture the burden of illness or treated diabetes as a dichotomous factor. Many of these approaches do not take into account the severity or functional impact of the disease when evaluating

outcomes after joint arthroplasty. While no single condition is completely responsible for the outcome after total joint arthroplasty, other conditions associated with diabetes also had significant deleterious effects on recovery, such as depression and kidney disease. Depression is not surprising because evidence has recognised that psychosocial symptoms such as depression are associated with osteoarthritis38 and 39 Isotretinoin and less pain relief and functional gains after TKA.40 and 41 Chronic kidney disease is a serious complication of diabetes,42 and 43 yet kidney disease had an independent effect on recovery after TKA. The interaction between diabetes and kidney disease was not significant. This is most likely because this cohort had a small proportion of kidney disease. The effect of kidney disease on recovery after TKA has not been explicitly examined in the literature and warrants further examination, given the profile of people who are at high risk for chronic kidney disease, such as diabetes or hypertension, also receiving TKA. A strength of our study was the method used to define the functional impact of diabetes. Diabetes was examined in the context of functional difficulty in performing routine activities, which was congruent with the measured outcomes, joint-specific pain and function.