Nutritional Status and Short-Term Outcome of Hip Arthroplasty

Abstract

purpose. To review nutritional status and outcome of 90 patients who underwent total hip arthroplasty (THA) or hemiarthroplasty. Methods. Records of 51 women and 39 men aged 26 to 96 (median, 71) years who underwent elective THA (n=48) for osteoarthritis, or trauma-related THA (n=10) or hemiarthroplasty (n=32) for subcapital femoral neck fractures using an uncemented femoral stem were retrospectively reviewed. Patient demographics and intra-and post-operative complications were recorded. Patient co-morbidities were assessed according to the Charlson grading system. Nutritional status was assessed using haematological markers of serum albumin (ALB) level and total lymphocyte count (TLC). Samples were taken on the day of the operation and within 24 hours of operation. Suboptimal nutrition was defined as a serum ALB level of <3.5 g/dl and a TLC of <1.50 cells/mm. elective patients were malnourished preoperatively (p<0.001). Preoperatively, more males than females had suboptimal ALB levels (28% vs. 8%, p=0.033) and TLC (82% vs. 31%, p<0.001). Age was inversely proportional to preoperative ALB and TLC values; patients older than 75 years had significantly lower values. Of those staying >7 days in hospital, 67% were aged >75 years as opposed to 31% were aged ≤75 years (p=0.001). Male gender, old age, and presentation with trauma were risk factors for suboptimal nutritional parameters (p<0.001 for all). Patients with suboptimal ALB and TLC values had a significantly longer stay in hospital (p=0.032 and p=0.021, respectively). conclusion. The rate of malnourishment was significantly higher in patients having traumarelated surgery than in those having elective surgery. Malnourished patients are at greater risk of prolonged hospital stay. Preoperative nutritional assessment may be useful in predicting patients at high surgical risk.

Low Albumin Levels, More Than Morbid Obesity, Are Associated With Complications After TKA

“…Other complications associated with malnutrition in patients undergoing orthopaedic surgery include postoperative hematoma formation, and renal, cardiovascular, and neurovascular complications [7]. Results of our study are consistent with those of other studies showing an association between low serum albumin and an increase in multiple major perioperative complications [5,12,27,32] To our knowledge, our study is the largest to date evaluating the independent association between low serum albumin and perioperative complications after TKA. We focused specifically on elective primary TKAs and provide a detailed analysis of specific complications which are increased in patients with low serum albumin.…”

“…Deep periprosthetic infections (acute and chronic) also have been reported at a higher rate in patients with malnutrition [32]. Some studies have concluded that patients with malnutrition had a longer postoperative length of stay [12,27]. Other complications associated with malnutrition in patients undergoing orthopaedic surgery include postoperative hematoma formation, and renal, cardiovascular, and neurovascular complications [7].…”

“…Benefits of TKA in populations at greater risk for complications are less well defined. Morbid obesity and malnutrition have been shown to be associated with increased perioperative complications after TKA [5,6,10,12,16,18,19,27,32]; however, some studies have not shown an increased risk of perioperative complications in patients who are morbidly obese [3,13,14,23,25]. In addition, patients with morbid obesity are more likely to be malnourished than patients who are not obese, raising the question whether morbid obesity, malnutrition, or both, are independently associated with increased perioperative complications [12].…”

Comparison of the Mini-Nutritional Assessment short and long form and serum albumin as prognostic indicators of hip fracture outcomes

“…Protein and energy malnutrition are common among older adults (1)(2)(3)(4)(5), with malnutrition and risk thereof especially high in hospitalized and institutionalized elderly patients. Two-thirds of older people may be at nutritional risk or malnourished (6,7).…”

“…Two-thirds of older people may be at nutritional risk or malnourished (6,7). Over half of hip fracture patients have a poor nutritional status (1,3,4,8). Malnutrition is acknowledged to be under-recognized and undertreated in health care (9).…”