Markers for Malnutrition and BMI Status in Total Joint Arthroplasty and Pharmaconutrient Therapy

Abstract

Evaluating the nutritional status of an orthopaedic patient prior to total joint arthroplasty can offer insight into potential postoperative outcomes.» Laboratory values, such as total lymphocyte count, serum albumin, and serum prealbumin, anthropometric measurements, and screening tools are all important resources in assessing nutritional status.» Using body mass index (BMI) in conjunction with laboratory values and other resources to adequately assess nutritional status can be effective in predicting outcomes after total joint arthroplasty.Disclosure: There was no source of external funding for this study. The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/ JBJSREV/A464).

Preoperative Patient Optimization in Total Joint Arthroplasty—The Paradigm Shift from Preoperative Clearance: A Narrative Review

“…One study found that interview-based screening tools performed preoperatively in hospitalized TJA patients, including the Nutritional Risk Screening (NRS 2002), Mini Nutritional Assessment (MNA), and Short-Form Mini Nutritional Assessment (SF-MNA), were able to predict risks of prolonged hospitalization, delayed mobilization, quality of life, and adverse events postoperatively [37]. In particular, the MNA has been shown to have a significant association with serum albumin and increased length of stay [67].…”

Team Approach: Nutritional Assessment and Interventions in Elective Hip and Knee Arthroplasty

“…Therefore, establishing routine pathways that enable the preoperative identification of malnourished or high-risk patients requires an interdisciplinary team, given the multifaceted nature of nutritional disorders 6 . Of note, frankly malnourished patients are those who are unable to achieve metabolic and nutrient requirements, resulting in clear deficiencies or compromised anthropometric measures 10,13 . However, another important patient subset may be "at nutritional risk," which is an abnormal metabolic state that can be detected and reversed preoperatively 10 .…”

“…While a plethora of published literature describes post-TJA adverse outcomes associated with malnutrition, studies providing interventional recommendations for preoperative nutritional status correction are scarce. The tenet of nutritional-status optimization is the correction of underlying abnormalities through nutrient-specific supplementation to reverse deficiencies 5,10 . In addition, general nutritional supplementation may aid in mitigating the risk of adverse outcomes (Table V).…”

“…Identification of malnourished patients and those at risk for malnutrition has become a tenet of care provision for such vulnerable populations 6,10 . While prior investigations questioned the utility of routine screening for nutrition-related disorders among primary TJA recipients 11 , recent prospective, large-scale studies have outlined added value inherent to implementing routine pathways to identify high-risk patients and provide nutritional intervention 4,12 .…”

“…Of note, frankly malnourished patients are those who are unable to achieve metabolic and nutrient requirements, resulting in clear deficiencies or compromised anthropometric measures 10,13 . However, another important patient subset may be "at nutritional risk," which is an abnormal metabolic state that can be detected and reversed preoperatively 10 . Some examples include patients with unfavorable social and environmental determinants or comorbid acute and chronic illnesses despite unremarkable or near-normal examinations and laboratory parameters.…”