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
Review
. 2023 Dec;33(8):3723-3727.
doi: 10.1007/s00590-023-03593-z. Epub 2023 May 31.

Why malnutrition in orthopaedic elective patient is still an issue? A recent review of the literature

Marco Pes  1 , Alessio Pulino  2 , Francesco Pisanu  2 , Andrea Fabio Manunta  2
Affiliations
Review

Why malnutrition in orthopaedic elective patient is still an issue? A recent review of the literature

Marco Pes et al. Eur J Orthop Surg Traumatol. 2023 Dec.

Abstract

Background: Malnutrition is a known risk factor for complications and adverse outcomes after elective total joint arthroplasty (TJA). The progressive increase in the ageing of world population and in the numbers of TJA, widens the demand for a faster post-operative recovery and function. The aim of this study was to review the literature regarding: post-operative transfusion, infections, wound complications, length of hospital stay (LOS), rate of admission in intensive care unit (ICU), and total patient charges, in malnourished patient undergoing TJA.

Methods: The search reviewed all fields of the available peer-reviewed literature, published in the English language during the last seven years 2015-2022. We started from a total of 745 studies and finally we included in the review 16 articles.

Results: In 10 studies, an increased surgical site infection was shown, being by far the most common complication, in 8 studies, malnutrition was associate with the increase of the average length of stay (LOS), and in 5 studies, the major founding was the increase in costs. An increase of the morbidity was found in 3 studies, instead a larger number of transfusions was highlighted in 2 studies. Lastly, one study showed a major unplanned ICU admission rate.

Conclusions: Although the literature trend indicates that the nutritional status of TJA candidate patients is a parameter that influences the surgical outcome, in particular surgical site infections, length of stay, and costs, there are, to the authors' knowledge, no studies aimed at identifying validated and recognized protocols for the correction of malnutrition.

Keywords: Arthroplasty; Elective surgery; Malnutrition; Risk factor.

PubMed Disclaimer

Conflict of interest statement

The author(s) declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart
See this image and copyright information in PMC

References

    1. Bala A, Ivanov DV, Huddleston JI, Goodman SB, Maloney WJ, Amanatullah DF, et al. The cost of malnutrition in total joint arthroplasty. J Arthroplasty. 2020;31(3):293–312. - PubMed
    1. Ihle C, Freude T, Bahrs C, Zehendner E, Braunsberger J, Biesalski HK, et al. Malnutrition—an underestimated factor in the inpatient treatment of traumatology and orthopedic patients: a prospective evaluation of 1055 patients. Injury. 2017;48(3):628–636. doi: 10.1016/j.injury.2017.01.036. - DOI - PubMed
    1. Schroer WC, LeMarr AR, Mills K, Childress AL, Morton DJ, Reedy ME. Chitranjan S. Ranawat award: elective joint arthroplasty outcomes improve in malnourished patients with nutritional intervention: a prospective population analysis demonstrates a modifiable risk factor. Bone Jt J. 2019;101B:17–21. doi: 10.1302/0301-620X.101B7.BJJ-2018-1510.R1. - DOI - PubMed
    1. Ljungqvist O, Dardai E, Allison SP. Basics in clinical nutrition: perioperative nutrition. e-SPEN. 2010;5(2):E93–E96. doi: 10.1016/j.eclnm.2009.06.011. - DOI
    1. Inacio MCS, Paxton EW, Graves SE, Namba RS, Nemes S. Projected increase in total knee arthroplasty in the United States—an alternative projection model. Osteoarthr Cartil. 2017;25(11):1797–1803. doi: 10.1016/j.joca.2017.07.022. - DOI - PubMed