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COMMENT: This is a WOW paper. As our population ages we are caring for an increasing number of patients who are undergoing these procedures, I have seen firsthand how debilitating osteoarthritis of the knee and hip can be and how liberating these replacement surgeries can be. However, this paper gives us pause. There are no free lunches in medicine. These finding should give us all pause as we evaluate our patients before and after surgery. This will be especially true for our patients with diabetes and therefor at increased risk.