Preoperative malnutrition is a risk factor for delayed recovery of mobilization after total hip arthroplasty

Nanri, Yuta; Shibuya, Manaka; Fukushima, Kazuhiko; Uchiyama, Katsufumi; Takahira, Naonobu; Takaso, Masashi

doi:10.1002/pmrj.12570

Cited by 15 publications

(8 citation statements)

References 40 publications

(109 reference statements)

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“…Several factors lead to delayed physical function recovery. 3–7 Walking ability and muscle strength are closely related, 8 and we reported the importance of preoperative quadriceps strength for early walking independence in older patients undergoing THA. 9 Furthermore, balance skills, including one-leg standing time (OLST), are known as good indicators of walking ability and are important for evaluating lower limb ability.…”

Section: Introductionmentioning

confidence: 76%

“…According to the postoperative clinical pathway in our hospital, sutures were removed on the 10th postoperative day and patients were discharged home on the 11th day if they were walking and climbing stairs independently at this point, but if they needed assistance with these activities, they were transferred to a rehabilitation facility. 5,7…”

Section: Methodsmentioning

confidence: 99%

“…The knowledge of which side function is more important for early postoperative walking independence has been shown to be important for planning pre- and postoperative management and rehabilitation in our institution. 5,7,9,12 Therefore, we hypothesised that the preoperative non-affected lower limb performance is also important for early postoperative gait independence, and the purpose of this study was to determine the impact of both lower limbs’ abilities on postoperative walking independence. We further examined the differences in effects on walking independence between both the sides.…”

Section: Introductionmentioning

confidence: 99%

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Association of affected and non-affected side ability with postoperative outcomes in patients undergoing total hip arthroplasty

Nozaki,

Nanri,

Kawabata

et al. 2023

HIP International

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Background: Although several reports have examined the association between preoperative function and postoperative outcomes in patients undergoing total hip arthroplasty (THA), it is unclear whether the ability of the affected or non-affected side particularly impacts on outcomes. We aimed to investigate the association between affected and non-affected side ability and walking independence. Methods: We prospectively enrolled 721 consecutive patients who underwent THA. Preoperatively, quadriceps isometric strength (QIS) and one-leg standing time (OLST) were measured. The endpoints were walking independence within 3, 5, 7, 10, and 14 days postoperatively. The associations between preoperative abilities and outcomes were examined using multivariate Cox hazard model, and the area under the curves (AUCs) for outcomes were compared. Results: We analysed 540 patients after excluding patients who met the exclusion criteria. Both affected and non-affected QIS predicted walking independence within 3 ( p = 0.006 and 0.001, respectively), 5, 7, 10, and 14 (both p < 0.001) days postoperatively. For OLST, only the affected side did not predict walking independence within 3 days postoperatively ( p = 0.154 and 0.012, respectively), and both sides did at days 5 ( p = 0.019 and <0.001, respectively), 7, 10, and 14 (both p < 0.001). The AUCs of the non-affected side ability for walking independence were significantly greater than those of the affected side on postoperative days 3 (0.66 vs. 0.73; p = 0.021) and 5 (0.67 vs. 0.71; p = 0.040), with no significant difference after day 7. Conclusions: Both sides abilities were associated with walking independence after THA, but non-affected side was found to be particularly crucial for early walking independence.

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Section: Introductionmentioning

confidence: 76%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Association of affected and non-affected side ability with postoperative outcomes in patients undergoing total hip arthroplasty

Nozaki,

Nanri,

Kawabata

et al. 2023

HIP International

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“…Regarding elective THA, Bala et al 13 queried the Medicare database from 2007 to 2016 and demonstrated a significant association between malnutrition and postoperative complications as well as significantly increased reimbursements in elective total joint arthroplasty. In addition, Nanri et al 28 reported that nutrition status assessed by the Controlling Nutritional Status (CONUT) score predicted delayed recovery of mobilization after THA. Furthermore, a recent meta‐analysis conducted by Tsantes et al 29 concluded that malnutrition is associated with the risk of surgical site and periprosthetic joint infections after total knee and hip arthroplasty 29 .…”

Section: Discussionmentioning

confidence: 99%

Effects of malnutrition on outcomes of patients with femoral head osteonecrosis undergoing total hip arthroplasty: A population‐based study

Chuang¹,

Yeh²,

Hung³

et al. 2023

Nut in Clin Prac

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BackgroundThis study aimed to evaluate the impact of malnutrition on in‐hospital outcomes in patients undergoing total hip arthroplasty (THA) for osteonecrosis of the femoral head (ONFH).MethodsThis population‐based retrospective study extracted data of patients undergoing THA for ONFH in the US National Inpatient Sample between 2005 and 2018. Factors associated with in‐hospital mortality, medical and surgical complications, unfavorable discharge, and prolonged hospital stay were determined by logistic regression analysis.ResultsA total of 72,304 adults ≥18 years old with nontraumatic ONFH admitted for primary THA were included. Malnutrition was detected in 7152 (9.9%) patients using validated discharge codes. In‐hospital mortality was 0.8% vs 0.1% for patients who were malnourished vs nonmalnourished. After adjusting for confounders, malnutrition was significantly associated with an increased risk of in‐hospital death (adjusted odds ratio [aOR], 4.67; 95% CI, 2.43–8.97), medical complications (aOR, 1.49; 95% CI, 1.32–1.68), surgical complications (aOR, 1.78; 95% CI, 1.61–1.96), unfavorable discharge (aOR, 1.24; 95% CI, 1.11–1.39), and prolonged hospital stay (aOR, 1.90; 95% CI, 1.67–2.16) compared with adequate nutrition. Malnutrition was also associated with higher total hospital costs (adjusted β = $9620; 95% CI, 7.87–11.36). Furthermore, the association between malnutrition, any medical or surgical complications, and unfavorable discharge was stronger in patients younger than 50 years than those ≥50 years old.ConclusionsIn US patients undergoing primary THA for ONFH, malnutrition increases the risk of unfavorable in‐hospital outcomes. This patient subgroup may require special attention and better strategies to improve perioperative care.

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“…Therefore, there is an urgent need to explore these well-validated INSTs in the field of arthroplasty. Nanri et al [ 43 ] evaluated 503 patients undergoing primary total hip arthroplasty and found that 18.9% were classified as malnourished by CONUT. Our study further revealed that the percentage of PJI patients identified as malnourished by CONUT raised to 48.1%.…”

Section: Discussionmentioning

confidence: 99%

Moderate-to-Severe Malnutrition Identified by the Controlling Nutritional Status (CONUT) Score Is Significantly Associated with Treatment Failure of Periprosthetic Joint Infection

Maimaiti

et al. 2022

Nutrients

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The prevalence and role of malnutrition in periprosthetic joint infection (PJI) remain unclear. This study aimed to use measurable nutritional screening tools to assess the prevalence of malnutrition in PJI patients during two-stage exchange arthroplasty and to explore the association between malnutrition and treatment failure. Our study retrospectively included 183 PJI cases who underwent 1st stage exchange arthroplasty and had available nutritional parameters, of which 167 proceeded with 2nd stage reimplantation. The recently proposed Musculoskeletal Infection Society (MSIS) Outcome Reporting Tool was used to determine clinical outcomes. The Controlling Nutritional Status (CONUT), Nutritional Risk Index (NRI), and Naples Prognostic Score (NPS) were used to identify malnutrition at 1st and 2nd stage exchange, respectively. Multivariate logistic regression analyses were performed to determine the association between malnutrition and treatment failure. Restricted cubic spline models were further used to explore the dose–response association. Additionally, risk factors for moderate-to-severe malnutrition were evaluated. Malnourished patients identified by CONUT, NPS, and NRI accounted for 48.1% (88/183), 98.9% (181/183), and 55.7% (102/183) of patients at 1st stage, and 9.0% (15/167), 41.9% (70/167), and 43.1% (72/167) at 2nd stage, indicating a significant improvement in nutritional status. We found that poorer nutritional status was a predictor of treatment failure, with CONUT performing best as a predictive tool. Moderate-to-severe malnutrition at 1st stage identified by CONUT was significantly related to treatment failure directly caused by PJI (odds ratio [OR] = 5.86), while the OR was raised to 12.15 at 2nd stage (OR = 12.15). The linear dose–response associations between them were also confirmed (P for nonlinearity at both 1st and 2nd stage > 0.05). As for total treatment failure, moderate-to-severe malnutrition as determined by CONUT was associated with a 1.96-fold and 8.99-fold elevated risk at the 1st and 2nd stages, respectively. Age ≥ 68 years (OR = 5.35) and an increased number of previous surgeries (OR = 2.04) may be risk factors for moderate-to-severe malnutrition. Overall, the prevalence of malnutrition in PJI patients is very high. Given the strong association between moderate-to-severe malnutrition identified by CONUT and PJI treatment failure, COUNT could be a promising tool to evaluate the nutritional status of PJI patients to optimize treatment outcomes.

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Preoperative malnutrition is a risk factor for delayed recovery of mobilization after total hip arthroplasty

Cited by 15 publications

References 40 publications

Association of affected and non-affected side ability with postoperative outcomes in patients undergoing total hip arthroplasty

Association of affected and non-affected side ability with postoperative outcomes in patients undergoing total hip arthroplasty

Effects of malnutrition on outcomes of patients with femoral head osteonecrosis undergoing total hip arthroplasty: A population‐based study

Moderate-to-Severe Malnutrition Identified by the Controlling Nutritional Status (CONUT) Score Is Significantly Associated with Treatment Failure of Periprosthetic Joint Infection

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