Clinical Orthopaedics and Related Research®

, Volume 473, Issue 1, pp 175–182 | Cite as

Is Potential Malnutrition Associated With Septic Failure and Acute Infection After Revision Total Joint Arthroplasty?

  • Paul H. Yi
  • Rachel M. Frank
  • Elliott Vann
  • Kevin A. Sonn
  • Mario Moric
  • Craig J. Della Valle
Symposium: 2014 Knee Society Proceedings
First Online:

Abstract

Background

Although malnutrition has been hypothesized to increase the risk of periprosthetic joint infection (PJI), strong evidence linking the two is lacking.

Questions/purposes

The purposes of this study were to determine (1) if one or more laboratory values suggestive of malnutrition is independently associated with being revised for an infected joint arthroplasty as opposed to for an aseptic failure; (2) the relationship between laboratory parameters suggestive of malnutrition and obesity; and (3) if one or more laboratory parameters suggestive of malnutrition is independently associated with acute PJI complicating an aseptic revision procedure.

Methods

Between 2002 and 2010, one surgeon performed 600 revision total joint arthroplasties in 547 patients; during that time, nutritional parameters (including serum albumin, total lymphocyte count, and transferrin) were routinely obtained preoperatively; complete data sets were available on 454 patients (501 procedures [84%]). We compared the frequency of having one or more laboratory parameters suggestive of malnutrition between patients undergoing a revision for septic reasons and aseptic reasons as well as between obese and nonobese patients. The 375 aseptic revisions were then assessed for the incidence of acute postoperative infection (within 90 days, diagnosed with Musculoskeletal Infection Society criteria). Multivariate logistic regression modeling was used to evaluate factors independently associated with (1) a septic as opposed to an aseptic mode of failure; and (2) acute postoperative infection after an aseptic revision.

Results

Patients in 67 of 126 (53%) revisions for PJI had one or more laboratory parameters suggestive of malnutrition compared with 123 of 375 (33%) undergoing revision for a noninfectious etiology (odds ratio [OR], 2.3 [95% confidence interval, 1.5–3.5]; p < 0.001). Patients who were of normal weight at the time of revision had the highest frequency of laboratory parameters suggestive of malnutrition (42 of 82 [51%]), although this was common in obese patients as well (76 of 238 [32%]) (p = 0.002). Among the 375 aseptic revisions, 12 developed an acute postoperative infection (3%). The frequency of infection was nine of 123 in the group having one or more laboratory parameters suggestive of malnutrition and three of 252 in the group not having such laboratory parameters (7% versus 1%; p = 0.003). Multivariate regression revealed that having laboratory parameters suggestive of malnutrition is independently associated with both chronic PJI (p = 0.003; OR, 2.1) and an acute postoperative infection complicating an aseptic revision arthroplasty (p = 0.02; OR, 5.9).

Conclusions

Having one or more laboratory parameters suggestive of malnutrition is common among patients undergoing revision arthroplasty and is independently associated with both chronic septic failure and acute postoperative infection complicating a revision performed for a noninfectious etiology. Future studies should assess the impact of a standardized screening protocol with subsequent correction of abnormal laboratory parameters suggestive of malnutrition on the risk of PJI to determine a potential causal relationship between the two.

Level of Evidence

Level III, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.

Keywords

Laboratory Parameter Total Joint Arthroplasty Periprosthetic Joint Infection Total Lymphocyte Count Aseptic Revision 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
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Notes

Acknowledgments

We thank Laura Quigley for her assistance in maintaining our institution’s total joint arthroplasty database.

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Copyright information

© The Association of Bone and Joint Surgeons® 2014

Authors and Affiliations

  • Paul H. Yi
    • 1
  • Rachel M. Frank
    • 1
  • Elliott Vann
    • 1
  • Kevin A. Sonn
    • 1
  • Mario Moric
    • 1
  • Craig J. Della Valle
    • 1
  1. 1.Midwest Orthopaedics at Rush University Medical CenterChicagoUSA

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