Significance of nutritional status in the development of periprosthetic infections

Abstract

Background Malnutrition caused by protein and vitamin deficiencies is a significant negative prognostic factor in surgical wound healing disorders and infections. Particularly in elective surgery, preoperative compensation of deficiencies is advisable to avoid negative postoperative consequences. This study examined the nutritional and protein balance of patients with periprosthetic hip and knee joint infections. Material and methods Patients with periprosthetic hip or knee joint infections constituted the study group (SG). Control group I (CG I) included patients with primary implants and CG II included patients who required revision surgery because of aseptic loosening. Relevant nutritional and protein parameters were determined via analysis of peripheral venous blood samples. In addition, a questionnaire was used to evaluate the nutritional and eating patterns of all patients. The nutritional risk screening (NRS) 2002 score and body mass index (BMI) were also calculated for all participants. Results Differences were found in the albumin level (SG: 36.23 ± 7.34, CG I: 44.37 ± 3.32, p < 0.001, CG II: 44.06 ± 4.24, p < 0.001) and total protein in serum (SG: 65.42 ± 8.66, CG I: 70.80 ± 5.33, p = 0.004, CG II: 71.22 ± 5.21, p = 0.004). The number of patients with lowered albumin levels (SG 19/61, CG I 1/78, CG II 2/55) and total protein in serum (SG: 12/61, CG I 5/78, CG II 2/55) also showed considerable variation. The number of patients with a NRS 2002 score ≥3 differed significantly between SG and both CGs (SG: 5/61, CG I 1/78, CG II 0/55); however, these differences could not be confirmed using BMI. Conclusion As expected, lowered albumin and total protein levels were observed in PJI due to the acute phase reaction. The NRS can be performed to exclude nutritional deficiency, which cannot be excluded based on BMI. In cases of periprosthetic joint infection it is reasonable to compensate the nutritional deficiency with dietary supplements.

Can the Preoperative Prognostic Nutrition Index (PNI) Predict Surgical Site Infection Following Primary Total Knee Arthroplasty?

“…The results of this study demonstrated that malnutrition is a risk factor associated with the development of SSI after primary TKA, and a similar result has been reported in several previous studies [11][12][13]. However, recently published large cohort studies contradicted this nding [22][23][24].…”

“…The impact of malnutrition on surgical outcomes following orthopaedic surgeries, especially primary and revision hip and knee arthroplasty, has been widely reported [11][12][13]. Increasing evidence has demonstrated that malnutrition is closely associated with postoperative wound complications including healing problems, persistent drainage, and deep infections [11][12][13]. A recent study further suggested that more than half of in-hospital elderly patients may have malnutrition [14].…”

Preoperative Risk Factors for Periprosthetic Joint Infection: A Narrative Review of the Literature

“…The term malnutrition is defined as a clinical condition characterized by low intakes of protein nutrients contributing to the patient’s frailty. According to the definition, malnutrition is characterized by serum albumin levels below 3.5 g/dL, serum transferrin levels below 200 mg/dL, serum prealbumin levels below 15 gm/dL, and total lymphocyte count (TLC) <1500 cells/mm 3 [ 61 ]. Some authors also incorporate hypovitaminosis, particularly vitamin D deficiency, into the definition, as this deficiency is associated with an increased risk of developing PJI, and its supplementation may decrease the infection risk [ 60 ].…”

Preoperative Prognostic Nutritional Index Is Useful Factor for Predicting Postoperative Delirium After Primary Total Joint Arthroplasty

“…The impact of malnutrition on surgical outcomes following orthopedic surgery has been widely reported [9][10][11][12][13][14], and recently published studies further demonstrated that preoperative malnutrition is closely associated with PD after orthopedic surgery [12][13][14]. Thus, preoperative screening and improvements are important for patients suspected of malnutrition to reduce PD following TJA.…”