Team Approach: Nutritional Assessment and Interventions in Elective Hip and Knee Arthroplasty

Abstract

Nutritional assessment is a critical element of routine preoperative assessment and should be approached by an interdisciplinary team that involves the primary care physician, dietitian, and orthopaedist.» Patients should be stratified on the basis of their nutritional risk, which influences downstream optimization and deficiency reversal.» The scientific literature indicates that nutritional supplementation affords protection against adverse outcomes and helps functional recovery, even among patients who are not at nutritional risk.» Published investigations recommend a sufficient preoperative interval (at least 4 weeks) to ensure an adequate nutritional intervention in malnourished patients as opposed to regarding them as nonsurgical candidates.Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSREV/A805).

CORR Insights®: Health Disparities in Patients With Musculoskeletal Injuries: Food Insecurity Is a Common and Clinically Challenging Problem

“…Because the patient’s PCP is often the uniting point of various elements of a patient’s care, this communication is helpful for establishing continuity and long-term follow-up. At PCP visits, tools like a 24-hour diet recall or a 7-day diet diary are useful in identifying and predicting food insecurity, bringing awareness to potential dietary derangements and identifying underlying risk factors [3]. Objective measurements such as trends in BMI are also useful in assessing nutrition.…”

“…Recommendations from all teams and any necessary follow-up should be clearly outlined in patient discharge instructions, and we need to make sure the patient understands those instructions. At discharge, communication among the patient's primary care professional (PCP) and the hospital's surgical, nutritional, and social work teams is critical [3]. Because the patient's PCP is often the uniting point of various elements of a patient's care, this communication is helpful for establishing continuity and long-term follow-up.…”

Malnutrition in total joint arthroplasty: what should the orthopaedic surgeon consider?

“…Due to the heterogeneity of definitions available and the lack of a gold standard in malnutrition assessment, there has been a wide range in the prevalence of malnutrition reported ( 26 , 27 ). The prevalence of malnutrition in the adult population has been reported to range from 15% to 60% ( 18 ).…”

“…Increased age, a history of gastrointestinal pathology, a history of malignancy, and alcohol abuse predispose patients to an increased risk of malnutrition ( 7 ). This highlights the holistic approach necessary for pre-operative optimisation, with the assessment of malnutrition beginning with a thorough medical history identifying co-morbidities ( 25 , 27 ).…”

“…The mini nutritional assessment (MNA) is useful in identifying patients who would benefit from nutritional intervention and has been suggested as the first-choice nutritional scoring tool due to its association with serum albumin and LOS ( 24 , 27 , 34 ). Ihle et al ( 35 ) evaluated the MNA in a prospective study on 351 TJA patients and found that inferior scores related to unfavourable LOS, post-operative mobilisation, and the incidence of adverse events.…”