Hypoalbuminemia and obesity class II are reliable predictors of peri-prosthetic joint infection in patient undergoing elective total knee arthroplasty

Abstract

Background: Malnutrition is a common and modifiable risk factor for postoperative complications and adverse outcomes in orthopedics. The purpose of this study was to identify biomarkers of malnutrition in patients undergoing elective total knee arthroplasty (TKA) that are predictive of adverse in-hospital postoperative complications, to facilitate the identification of at-risk patients for nutritional optimization before surgery. Methods: A total of 624 patients who underwent elective TKA between 2013 and 2017 were evaluated; potential biomarkers of preoperative malnutrition, including hypoalbuminemia (serum albumin < 3.5 g/dL), total lymphocyte count (TLC < 1500 cells/mm 3), and body mass index (BMI), were assessed for any association with in-hospital postoperative complications. Results: The prevalence of hypoalbuminemia, low TLC, overweight, obesity class I, and obesity class II were, respectively 2.72%, 33.4%, 14.8%, 44.5%, and 26.9%. There was a significant association between hypoalbuminemia and obesity class II (BMI ≥ 30.0 kg/m 2) with rates of peri-prosthetic joint infection, and no significant association between such complications and low TLC, overweight, or obesity class I. Logistic regression analysis showed that patients with hypoalbuminemia or being in obesity class II with gouty arthritis were more likely to suffer from periprosthetic joint infection. Conclusions: Hypoalbuminemia and obesity class II together is a reliable biomarker of preoperative malnutrition for predicting peri-prosthetic joint infection after elective TKA, whereas low TLC, overweight, and obesity class I were not significantly associated with an increased risk of such complications.

Traditional Chinese-Hong Kong version of Forgotten Joint Score-12 (FJS-12) for patients with osteoarthritis of the knee underwent joint replacement surgery: cross-cultural and sub-cultural adaptation, and validation

“…A recent report projected the obesity trend in 2030 that the number of people who are overweigh might reach a total of 2.16 billion and another 1.12 billion obese population, or 38% and 20% of the world's adult population respectively [ 47 ]. Mean BMI of patients in our previous studies always fell within “overweight” or “obese” categories [ 48 – 50 ]. Consequently, a PRO questionnaire for patients underwent TKA is important to provide accurate and high responsiveness to the respondents (patients) who are “overweight” or “obese”.…”

Preoperative High-Protein Diet Can Improve The Serum Albumin Levels of Patients Undergoing Total Knee Arthroplasty

“…Albumin is well known among clinicians for its reliability and sensitivity for assessing nutritional status [16]. Hypoproteinemia can lead to a signi cantly higher incidence of postoperative complications including delayed wound healing due to reduced collagen synthesis and protein matrix deposition [17,18] and super cial or deep infection caused by diminished immune response [19], and adverse events such as myocardial infarction, cardiac arrest, stroke and even mortality in TJA [10,18].…”

“…This population accounts for the majority of patients undergoing TKA. Fortunately, compared with emergency operation, the elective nature of TJA allows these patients to have an adequate preoperative nutritional storage for reducing the risk of postoperative HAS use [16,25]. One study [26] reported that a high-protein diet could improve the overall survival for older adults diagnosed with advanced gastrointestinal cancer.…”

The Paradox of Prosthetic Joint Infection and the Microbiome: Are Some Bacteria Actually Helpful?

“…Conversely, undernourished patients with low body mass index are also at an increased risk of PJI [ 30 ]. The unifying link between underweight patients, overweight patients, and those who underwent weight reduction surgery that results in increased PJI risk may be nutritional deficits [ 31 ]. Malnutrition and obesity are both conditions that are linked to dysfunction of the microbiome, as obese and undernourished patients both have reduced diversity of the gut microbiota [ 32 ].…”