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Living with diabetes does not automatically mean that you cannot undergo knee replacement surgery. Many people with diabetes successfully have knee replacement and return to improved mobility with significant relief from knee pain.
However diabetes can influence wound healing, infection risk and recovery after surgery. This makes proper blood sugar management before knee replacement especially important.
If you have diabetes and are considering knee replacement surgery this guide explains what you should know before surgery and how good diabetes control can help support a safer recovery.
Can a Person With Diabetes Have Knee Replacement Surgery?
Yes. People with diabetes can undergo knee replacement surgery.
The important question is usually not simply whether you have diabetes. Your surgical team will want to know how well your diabetes is controlled and whether you have other health conditions that may affect surgery.
Before surgery your orthopaedic surgeon may work with your physician, diabetologist or anaesthetist to evaluate your overall health and develop a suitable perioperative plan.
Why Does Diabetes Matter Before Knee Replacement?
Knee replacement is a major surgical procedure. During surgery and recovery the body experiences physical stress which can temporarily affect blood glucose levels.
Poorly controlled blood sugar may interfere with normal healing and can increase the possibility of certain postoperative complications.
Research evaluating patients undergoing total knee replacement has found that diabetes is associated with a higher risk of complications including periprosthetic joint infection. Good perioperative glycaemic control is considered an important modifiable factor when preparing diabetic patients for surgery.
This does not mean that every patient with diabetes will experience complications. It means that diabetes should be carefully managed as part of the overall surgical preparation.
What Is HbA1c and Why Is It Important Before Surgery?
HbA1c is a blood test that provides an estimate of your average blood glucose level over approximately the previous two to three months.
Your surgeon may request an HbA1c test before knee replacement to understand how well your diabetes has been controlled.
According to the American Diabetes Association Standards of Care in Diabetes 2026 an HbA1c goal below 8% within three months of elective surgery is recommended to help improve postoperative outcomes. The target should still be individualized according to the patient’s overall health and risk profile.
Your surgeon or diabetes specialist may recommend a different target based on factors such as:
- Your age
- Type and duration of diabetes
- Current diabetes medications
- Kidney function
- Heart health
- Previous episodes of low blood sugar
- Other medical conditions
Therefore patients should not try to rapidly reduce blood sugar or change medication without medical supervision.
What Blood Sugar Level Is Recommended Around Surgery?
Managing glucose is important not only before surgery but also during the hospital stay.
Current ADA guidance recommends monitoring blood glucose before surgery, during surgery and after surgery with a general perioperative target of 100–180 mg/dL. Individual targets may vary depending on the patient’s health and treatment.
Your hospital team may monitor your glucose more frequently than you normally do at home because factors such as fasting, medications, surgical stress and changes in food intake can affect blood sugar.
Does Diabetes Increase Infection Risk After Knee Replacement?
Diabetes is recognised as one of several factors that may increase the risk of infection following total knee replacement.
A large systematic review involving more than 120,000 knees found a higher risk of infection among patients with diabetes compared with patients without diabetes.
Blood sugar control is particularly important because persistent hyperglycaemia can affect immune function and healing.
Other factors can also influence infection risk including obesity, smoking, nutritional status and existing medical conditions.
Your surgeon will consider the complete clinical picture rather than diabetes alone.
Can High Blood Sugar Delay Knee Replacement Surgery?
Sometimes.
If blood sugar levels are significantly uncontrolled your surgeon may recommend improving diabetes management before proceeding with an elective knee replacement.
The objective is not to prevent you from having surgery. The aim is to make the procedure as safe as reasonably possible.
It is also important to understand that HbA1c should not be considered in isolation. The 2026 ADA guidance notes that postponing surgery solely on the basis of HbA1c or glucose management indicators may unnecessarily delay required treatment. Surgical decisions should be individualized.
What Tests May Be Required Before Knee Replacement?
Preoperative evaluation may vary between patients. A person with diabetes may be advised to undergo tests such as:
- HbA1c
- Fasting or random blood glucose
- Complete blood count
- Kidney function tests
- Electrolytes
- ECG when clinically indicated
- Urine examination when required
- Other investigations based on age and medical history
The objective of preoperative evaluation is to identify factors that can be optimized before surgery.
Patients with long-standing diabetes may also have associated conditions involving the kidneys, nerves, blood vessels or heart. These factors may need additional assessment before knee replacement.
What Happens to Diabetes Medicines Before Surgery?
Do not independently stop insulin or diabetes medication before knee replacement.
Some medications may need to be temporarily modified because patients are usually asked to fast before surgery.
Current diabetes guidelines include specific perioperative recommendations for medications such as metformin, SGLT2 inhibitors and insulin. The exact plan depends on the medication and individual patient circumstances.
Your surgeon, anaesthetist or diabetes specialist should provide clear instructions about:
- Which medicines to continue
- Which medicines may need to be stopped temporarily
- Insulin dose adjustments
- When you should stop eating
- When you should stop drinking
- What to do if your blood sugar becomes unusually high or low
Always follow the medication instructions given specifically for your surgery.
Blood Sugar Monitoring After Knee Replacement
Blood glucose may fluctuate after surgery even when diabetes was previously well controlled.
Possible reasons include:
Surgical stress:
The body’s hormonal response to surgery can temporarily raise blood glucose.
Changes in diet:
Food intake immediately after surgery may differ from your normal routine.
Reduced activity:
Physical activity levels change during the first few days of recovery.
Medication changes:
Some medicines used during hospital treatment can affect glucose levels.
For these reasons your medical team may regularly monitor glucose during the postoperative period and modify treatment when necessary.
Does Diabetes Slow Recovery After Knee Replacement?
Recovery is different for every patient.
Diabetes does not necessarily mean that your knee replacement recovery will be poor. However uncontrolled diabetes may make wound healing and postoperative management more challenging.
Patients can support recovery by following their prescribed physiotherapy program, taking medicines correctly and maintaining appropriate blood glucose control.
Early mobilization after knee replacement is generally an important part of rehabilitation when the surgeon considers it safe.
How Can Diabetic Patients Prepare for Knee Replacement?1
Preparation should ideally begin before the day of surgery.
1. Get Your HbA1c Checked
Know your recent HbA1c and discuss the result with your doctor.
2. Keep Blood Sugar Well Controlled
Follow your prescribed diet, medication and glucose monitoring plan.
3. Inform Your Surgeon About All Medicines
Share details of insulin, tablets and any other medications or supplements you take.
4. Follow Preoperative Instructions Carefully
Follow your hospital’s instructions regarding fasting and medication changes.
5. Maintain Good Nutrition
Adequate nutrition supports recovery and wound healing.
6. Stop Smoking
Smoking can negatively affect healing and should ideally be stopped before surgery.
7. Prepare for Physiotherapy
Rehabilitation is an important part of achieving good mobility after knee replacement.
8. Watch Your Surgical Wound
After discharge follow your surgeon’s wound-care instructions carefully.
Contact your treating team if you develop concerning symptoms such as increasing redness, unusual wound discharge, persistent fever or rapidly worsening pain.
FAQ
Knee replacement can be performed in people with diabetes. The individual risk depends on blood sugar control and other medical factors. Careful preoperative assessment and perioperative glucose management are important.
The American Diabetes Association’s 2026 Standards of Care recommend a preoperative HbA1c goal below 8% within three months for elective surgery with individualized assessment. Your treating doctors may recommend a different goal depending on your health.
Possibly but the decision is individualized. Your surgeon may recommend improving diabetes control before elective surgery if your glucose is poorly controlled.
Diabetes does not mean that an infection will occur. However research shows that patients with diabetes have a higher overall risk of infection after total knee replacement. Good glucose management may help reduce modifiable risk.1
Do not stop medication yourself. Your surgeon, physician or anaesthetist will tell you which medicines need adjustment before surgery.
Many diabetic patients can achieve good recovery after knee replacement. Blood sugar management, physiotherapy, wound care and regular follow-up are particularly important.
Knee Replacement for Diabetic Patients in Nagpur
Patients with diabetes considering knee replacement surgery in Nagpur should discuss both their knee condition and diabetes management during their surgical consultation.
A structured preoperative assessment can help identify blood sugar concerns and other medical conditions that may need optimization before surgery.
Dr. Utsav Agrawal is an Orthopaedic & Joint Replacement Surgeon practising at Varunam Super Speciality Hospital in Ramdaspeth, Nagpur with a clinical focus that includes joint replacement care.
Patients considering knee replacement can consult an orthopaedic surgeon for an individualized assessment rather than deciding about surgery based only on their diabetes diagnosis.
Call: +91 7447799000
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Visit: Varunam Super Speciality Hospital, Ramdaspeth, Nagpur