The effect of sarcopenia on outcomes following orthopaedic surgery

Abstract

Aims Sarcopenia is characterized by a generalized progressive loss of skeletal muscle mass, strength, and physical performance. This systematic review primarily evaluated the effects of sarcopenia on postoperative functional recovery and mortality in patients undergoing orthopaedic surgery, and secondarily assessed the methods used to diagnose and define sarcopenia in the orthopaedic literature. Methods A systematic search was conducted in MEDLINE, EMBASE, and Google Scholar databases according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Studies involving sarcopenic patients who underwent defined orthopaedic surgery and recorded postoperative outcomes were included. The quality of the criteria by which a diagnosis of sarcopenia was made was evaluated. The quality of the publication was assessed using Newcastle-Ottawa Scale. Results A total of 365 studies were identified and screened, 26 full-texts were reviewed, and 19 studies were included in the review. A total of 3,009 patients were included, of whom 2,146 (71%) were female and 863 (29%) were male. The mean age of the patients was 75.1 years (SD 7.1). Five studies included patients who underwent spinal surgery, 13 included hip or knee surgery, and one involved patients who underwent fixation of a distal radial fixation. The mean follow-up was 1.9 years (SD 1.9; 5 days to 5.6 years). There was wide heterogeneity in the measurement tools which were used and the parameters for the diagnosis of sarcopenia in the studies. Sarcopenia was associated with at least one deleterious effect on surgical outcomes in all 19 studies. The postoperative rate of mortality was reported in 11 studies (57.9%) and sarcopenia was associated with poorer survival in 73% (8/11) of these. The outcome was most commonly assessed using the Barthel Index (4/19), and sarcopenic patients recorded lower scores in 75% (3/4) of these. Sarcopenia was defined using the gold-standard three parameters (muscle strength, muscle quantity or quality, and muscle function) in four studies (21%), using two parameters in another four (21%) and one in the remaining 11 (58%). The methodological quality of the studies was moderate to high. Conclusion There is much heterogeneity in the reporting of the parameters which are used for the diagnosis of sarcopenia, and evaluating the outcome of orthopaedic surgery in sarcopenic patients. However, what data exist suggest that sarcopenia impairs recovery and increases postoperative mortality, especially in patients undergoing emergency surgery. Further research is required to develop processes that allow the accurate diagnosis of sarcopenia in orthopaedics, which may facilitate targeted pre- and postoperative interventions that would improve outcomes. Cite this article: Bone Joint J 2022;104-B(3):321–330.

Psoas Cross-Sectional Measurements Using Manual CT Segmentation before and after Endovascular Aortic Repair (EVAR)

“…Sarcopenia is a progressive and generalized skeletal muscle disorder, whose diagnostic pathway includes measurements of muscle mass, muscle strength and physical performance [ 1 ]. While this condition is well known to the aging literature, recent studies have emphasized its relevance in various clinical settings, such as cancer and surgery [ 2 , 4 ]. As a result, the term sarcopenia is currently used as a synonym for low muscle mass and myosteatosis is often considered as an aspect of the disorder, rather than a distinct entity [ 22 ].…”

“…Sarcopenia is a progressive and generalized disorder characterized by accelerated loss of skeletal muscle mass, strength and functionality [ 1 ]. It was found to be associated with an increase in morbidity and mortality in various conditions such as cancer, and orthopedic and abdominal surgery [ 2 , 3 , 4 ]. A great range of techniques can be used to assess muscle mass, with no established consensus on a reference standard so far [ 5 ].…”

Assessing Muscle Mass in the Orthopedic Clinical Setting: Application of the Ultrasound Sarcopenia Index in Elderly Subjects with a Recent Femoral Fracture

“…To obtain a correct diagnosis, two of the three following criteria are required: low skeletal muscle mass, inadequate muscle strength, inadequate physical performance [ 2 ]. From an epidemiologic standpoint, about 44% of elderly who undergo orthopedic surgery and up to 24% of all patients between 65 and 70 years old are sarcopenic [ 3 ]. Within orthopedic surgery, sarcopenia has been observed as a risk factor for unfavorable postoperative outcomes, especially in the emergency setting.…”

Muscle size and density are independently associated with death after hip fracture: A prospective cohort study

“…Sarcopenia is characterized by the loss of muscle mass and strength 10 and is highly prevalent in hip fracture patients 11 . In addition, sarcopenia has recently been found to be associated with a higher risk of mortality in older hip fracture patients 12 . Due to their widespread availability and ease of use, skeletal muscle mass is usually estimated by measuring lean mass with dual energy X‐ray absorptiometry (DXA) or bioelectrical impedance analysis (BIA).…”

“…11 In addition, sarcopenia has recently been found to be associated with a higher risk of mortality in older hip fracture patients. 12 Due to their widespread availability and ease of use, skeletal muscle mass is usually estimated by measuring lean mass with dual energy X-ray absorptiometry (DXA) or bioelectrical impedance analysis (BIA). The limitations of DXA and BIA to directly measure muscle mass may be one reason that the results of these two techniques to predict post-hip fracture mortality have been inconsistent.…”