What Is the Role of Nutritional Supplements in Support of Total Hip Replacement and Total Knee Replacement Surgeries? A Systematic Review

Abstract

Nutritional supplements can influence outcomes for individuals undergoing major surgery, particularly in older persons whose functional reserve is limited. Accelerating recovery from total hip replacement (THR) and total knee replacement (TKR) may offer significant benefits. Therefore, we explored the role of nutritional supplements in improving recovery following THR and TKR. A systematic review was conducted to source randomized clinical trials that tested nutritional supplements in cohorts of THR or TKR patients. Our search yielded nine relevant trials. Intake of a carbohydrate-containing fluid is reported to improve insulin-like growth factor levels, reduce hunger, nausea, and length of stay, and attenuate the decrease in whole-body insulin sensitivity and endogenous glucose release. Amino acid supplementation is reported to reduce muscle atrophy and accelerate return of functional mobility. One paper reported a suppressive effect of beta-hydroxy beta-methylbutyrate, l-arginine, and l-glutamine supplementation on muscle strength loss following TKR. There is limited evidence for nutritional supplementation in THR and TKR pathways; however, the low risk profile and potential benefits to adjunctive treatment methods, such as exercise programs, suggest nutritional supplements may have a role. Optimizing nutritional status pre-operatively may help manage the surgical stress response, with a particular benefit for undernourished, frail, or elderly individuals.

A randomised controlled study of preoperative oral carbohydrate loading versus fasting in patients undergoing colorectal surgery

“…Henrixen et al found no influence on the VAS well-being score after CHO administration in colorectal surgery. The anaesthesia protocol in this study included epidural anaesthesia, which possibly modulated the magnitude of surgical stress and could influence the intervention [30]. In our study, the CHO drink did not significantly improve the VAS pain score.…”

Incidence and Risk Factors Associated with Human Albumin Administration Following Total Joint Arthroplasty.

“…Moreover, in a similar prospective study that evaluated the effectiveness of perioperative essential amino acid supplementation, Ueyama et al [4] demonstrated a signi cant increase in serum albumin with essential amino acid supplementation compared with placebo. A systematic review on the role of nutritional supplements in support of THA and TKA by Burgess et al [13] concluded that optimizing nutritional status preoperatively may help manage the surgical stress response, with a particular bene t for undernourished, frail, or elderly individuals.…”

Pre- and Post-Surgical Nutrition for Preservation of Muscle Mass, Strength, and Functionality Following Orthopedic Surgery

“…Where direct evidence in surgical patients is limited, applied data from sport and injury recovery has been applied. For further information on other nutritional considerations and strategies to facilitate surgical recovery and rehabilitation, such as micronutrient intake and dietary supplements, readers are directed to other reviews [ 20 , 21 ].…”

“…Special attention should be given to nutritional intake in the 24 h period prior to surgery ( Figure 1 ). Historically, strict fasting procedures have restricted nutritional intake in the hours before surgery due to concerns of regurgitation or aspiration under anesthesia [ 21 ]. As understanding of gastrointestinal motility, the harmful effects of long fasting periods on metabolic stress, insulin sensitivity, and recovery have improved, pre-surgical fasting recommendations have been revised.…”