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Nutritional Assessment and Interventions in Elective Hip and Knee Arthroplasty: a Detailed Review and Guide to Management

  • Reverse Shoulder Arthroplasty (E Craig, Section Editor)
  • Published:
Current Reviews in Musculoskeletal Medicine Aims and scope Submit manuscript

Abstract

Purpose of Review

8.5 to 50% of total joint arthroplasty (TJA) patients are reported to have preoperative malnutrition. The narrative review identifies the relationship between preoperative malnutrition for TJA patients and postoperative outcomes as well as the use of perioperative nutritional intervention to improve postoperative complications.

Recent Findings

Biochemical/laboratory, anthropometric, and clinical measures have been widely used to identify preoperative nutritional deficiency. Specifically, serum albumin is the most prevalent used marker in TJA because it has been proven to be correlated with protein-energy malnutrition due to the surgical stress response. However, there remains a sustained incidence of preoperative malnutrition in total knee arthroplasty (TKA) and total hip arthroplasty (THA) patients due to a lack of agreement among the available nutritional screening tools and utilization of isolated laboratory, anthropometric, and clinical variables. Previous investigations have also suggested preoperative malnutrition to be a prognostic indicator of complications in general, cardiac, vascular, and orthopaedic surgery specialties.

Summary

Serum albumin, prealbumin, transferrin, and total lymphocyte count (TLC) can be used to identify at-risk patients. It is important to employ these markers in the preoperative setting because malnourished TKA and THA patients have shown to have worse postoperative outcomes including prolonged length, increased reoperation rates, increased infection rates, and increased mortality rates. Although benefits from high-protein and high-anti-inflammatory diets have been exhibited, additional research is needed to confirm the use of perioperative nutritional intervention as an appropriate treatment for preoperative TJA patients.

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References

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  1. Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, 44195, USA

    Michael D. Dubé, Christopher A. Rothfusz, Ahmed K. Emara, Matthew Hadad, Peter Surace, Viktor E. Krebs, Robert M. Molloy & Nicolas S. Piuzzi

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The conceptualization and idea for the article came from MH, MD and NSP, MD. The literature search and data analysis were performed by MDD, BS. The first draft of the manuscript was written by MDD, BS and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Nicolas S. Piuzzi.

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Dubé, M.D., Rothfusz, C.A., Emara, A.K. et al. Nutritional Assessment and Interventions in Elective Hip and Knee Arthroplasty: a Detailed Review and Guide to Management. Curr Rev Musculoskelet Med 15, 311–322 (2022). https://doi.org/10.1007/s12178-022-09762-7

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