Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Sep;143(9):5641-5648.
doi: 10.1007/s00402-023-04885-z. Epub 2023 Apr 18.

Hypoalbuminemia increases the risk of failure following one-stage septic revision for periprosthetic joint infection

Giacomo Traverso  1   2 , Jorge H Núñez  3 , Thorsten Gehrke  1 , Mustafa Citak  1
Affiliations

Hypoalbuminemia increases the risk of failure following one-stage septic revision for periprosthetic joint infection

Giacomo Traverso et al. Arch Orthop Trauma Surg. 2023 Sep.

Abstract

Purpose: Malnutrition is a potentially modifiable risk factor of periprosthetic joint infection (PJI). The purpose of this study was to analyze the role of nutritional status as a risk factor for failure after one- stage revision hip or knee arthroplasty for PJI.

Methods: Retrospective, single-center, case-control study. Patients with PJI according to the 2018 International Consensus Meeting criteria were evaluated. Minimum follow-up was 4 years. Total lymphocyte count (TLC), albumin values, hemoglobin, C-reactive protein, white blood cell (WBC) count and glucose levels were analyzed. An analysis was also made of the index of malnutrition. Malnutrition was defined as serum albumin < 3.5 g/dL and TLC < 1500/mm3. Septic failure was defined as the presence of local or systemic symptoms of infection and the need of further surgery as a result of persistent PJI.

Results: No significant differences were found between increased failure rates after a one-stage revision hip or knee arthroplasty for PJI and TLC, hemoglobin level, WBC count, glucose levels, or malnutrition. Albumin and C-reactive protein values were found to have a positive and significant relationship with failure (p < 0.05). Multivariate logistic regression identified only hypoalbuminemia (serum albumin < 3.5 g/dL) (OR 5.64, 95% CI 1.26-25.18, p = 0.023) as a significant independent risk factor for failure. The receiver operating characteristic (ROC) curve for the model yielded an area under the curve of 0.67.

Conclusion: TLC, hemoglobin; WBC count; glucose levels; and malnutrition, understood as the combination of albumin and TLC, were not found to be statically significant risk factors for failure after single-stage revision for PJI. However, albumin < 3.5 g/dL, alone was a statically significant risk factor for failure after single-stage revision for PJI. As hypoalbuminemia seems to influence the failure rate, it is advisable to measure albumin levels in preoperative workups.

Keywords: Albumin; Malnutrition; Periprosthetic joint infection; Single–stage revision; Total lymphocyte count.

PubMed Disclaimer

Similar articles

See all similar articles

Cited by

References

    1. Tsantes AG, Papadopoulos DV, Lytras T, Tsantes AE, Mavrogenis AF, Korompilias AV, Gelalis ID, Tsantes CG, Bonovas S (2019) Association of malnutrition with periprosthetic joint and surgical site infections after total joint arthroplasty: a systematic review and meta-analysis. J Hosp Infect 103:69–77. https://doi.org/10.1016/j.jhin.2019.04.020 - DOI - PubMed
    1. Bala A, Ivanov DV, Huddleston JI, Goodman SB, Maloney WJ, Amanatullah DF (2020) The cost of malnutrition in total joint arthroplasty. J Arthroplasty 35:926–932. https://doi.org/10.1016/j.arth.2019.11.018 - DOI - PubMed
    1. Kurtz S, Ong K, Lau E, Mowat F, Halpern M (2007) Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Jt Surg Am 89:780–785. https://doi.org/10.2106/JBJS.F.00222 - DOI
    1. Cizmic Z, Feng JE, Huang R, Iorio R, Komnos G, Kunutsor SK, Metwaly RG, Saleh UH, Sheth N, Sloan M (2019) Hip and knee section, prevention, host related: proceedings of international consensuson orthopedic infections. J Arthroplasty 34:255–270. https://doi.org/10.1016/j.arth.2018.09.010 - DOI
    1. Ryan SP, Politzer C, Green C, Wellman S, Bolognesi M, Seyler T (2018) Albumin versus American society of anesthesiologists score: which is more predictive of complications following total joint arthroplasty? Orthopedics 41:354–362. https://doi.org/10.3928/01477447-20181010-05 - DOI - PubMed

MeSH terms

LinkOut - more resources