Impact of malnutrition on postoperative outcomes in total knee arthroplasty: a comprehensive analysis

Authors

  • Maqbal Muhasin Nazar I. M. Department of Orthopaedics, Government Medical College, Kozhikode, Kerala, India
  • Jojo Inassi Department of Orthopaedics, Government Medical College, Kozhikode, Kerala, India
  • Balaji Zacharia Department of Orthopaedics, Government Medical College, Kozhikode, Kerala, India
  • Sharafuddeen Mammu Department of Orthopaedics, Government Medical College, Kozhikode, Kerala, India
  • Nidhin Chacko V. H. Department of Orthopaedics, Government Medical College, Kozhikode, Kerala, India
  • Athish K. C. Department of Orthopaedics, Government Medical College, Kozhikode, Kerala, India

DOI:

https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20243127

Keywords:

Total knee arthroplasty, Malnutrition, Infection, Hypoalbuminemia

Abstract

Introduction: Malnutrition has been shown to cause perioperative complications, which can be particularly detrimental following total knee arthroplasty (TKA). These complications can lead to increased morbidity, extended hospital stays, and significant financial burdens on both patients and healthcare systems. To evaluate the nutritional status and body mass index (BMI) of patients undergoing TKA and monitor them for complications immediately postoperatively, at one week, and three months after surgery.

Methods: This prospective study included 88 patients who underwent TKA at government medical college Kozhikode, Kerala, India. Nutritional status was assessed using serum albumin, ferritin, haemoglobin, and BMI (body mass index) levels. Patients were followed up for three months postoperatively to identify any complications. Data analysis was conducted to determine the relationship between malnutrition and postoperative complications.

Results: Of the 88 patients, 5 developed major wound complications, with 4 of these patients exhibiting hypoalbuminemia. Hypoalbuminemia was found to have a statistically significant association with major wound complications (p<0.001). Malnutrition was associated with higher rates of major wound complications, increased need for postoperative blood transfusions, and longer hospital stays.

Conclusion: Identifying modifiable risk factors such as malnutrition in patients undergoing TKA is crucial for reducing the risk of postoperative complications, which can otherwise lead to disastrous outcomes. Preoperative optimization of nutritional status can significantly improve surgical outcomes and reduce complications.

Metrics

Metrics Loading ...

References

Schwartz AM, Wilson JM, Farley KX, Bradbury TL, Guild GN. Concomitant malnutrition and frailty are uncommon, but significant risk factors for mortality and complication following primary total knee arthroplasty. J Arthroplasty. 2020;35(10):2878-85.

Wolford ML, Palso K, Bercovitz A. Hospitalization for total hip replacement among inpatients aged 45 and over: United States, 2000–2010. NCHS Data Brief. 2015;(186):1-8.

Ellsworth B, Kamath AF. Malnutrition and total joint arthroplasty. J Nat Sci. 2016;2(3):179.

Cross MB, Yi PH, Thomas CF, Garcia J, Della Valle CJ. Evaluation of malnutrition in orthopaedic surgery. J Am Acad Orthop Surg. 2014;22(3):193-9.

Misra A, Chowbey P, Makkar BM. Consensus statement for diagnosis of obesity, abdominal obesity and the metabolic syndrome for Asian Indians and recommendations for physical activity, medical and surgical management. J Assoc Physicians India. 2009;57:163-70.

Rudasill S, Gittings DJ, Elkassabany NM, Liu J, Nelson CL, Kamath AF. Preoperative Risk Factor Score Predicts Malnutrition in Total Joint Arthroplasty Patients. J Surg Orthop Adv. 2019;28(2):97-103.

Fu MC, McLawhorn AS, Padgett DE, Cross MB. Hypoalbuminemia is a better predictor than obesity of complications after total knee arthroplasty: a propensity score-adjusted observational analysis. HSSJ. 2017;13(1):66-74.

Roche M, Law TY, Kurowicki J, Sodhi N, Rosas S, Elson L, Summers S, Sabeh K, Mont MA. Albumin, prealbumin, and transferrin may be predictive of wound complications following total knee arthroplasty. J Knee Surg. 2018;31(10):946-51.

Kamath AF, Nelson CL, Elkassabany N, Guo Z, Liu J. Low Albumin Is a Risk Factor for Complications after Revision Total Knee Arthroplasty. J Knee Surg. 2017;30(3):269-75.

Myers WT, Leong M, Phillips LG. Optimizing the patient for surgical treatment of the wound. Clin Plast Surg. 2007;34(04):607–20.

Ethridge RT, Leong M, Phillips LG. Wound healing. Sabiston textbook of surgery: The biological basis of modern surgical practice. 20th ed. Philadelphia: Elsevier. 2017:130-62.

Robson MC, Phillips LG, Lawrence WT. The safety and effect of topically applied recombinant basic fibroblast growth factor on the healing of chronic pressure sores. Ann Surg. 1992;216(04):401-6.

Liu L, Liu L, Liang LC,Zhu ZQ, Wan X, Dai HB et al. Impact of preoperative anemia on perioperative outcomes in patients undergoing elective colorectal surgery. Gastroenterol Res Pract. 2018;11:2417028.

Shaw JG. Iron deficiency anaemia: focus on infectious diseases in lesser developed countries. Anemia. 2011; 1:260380.

Viana MB. Anemia and infection: a complex relationship. Rev Bras Hematol Hemoter. 2011;33(2):90-2.

Bursi F, Barbieri A, Politi L, Di Girolamo A, Malagoli A, Grimaldi T, et al. Perioperative red blood cell transfusion and outcome in stable patients after elective major vascular surgery. Eur J Vasc Endovasc Surg. 2009;37(3):311-8.

Downloads

Published

2024-10-25

How to Cite

I. M., M. M. N., Inassi, J., Zacharia, B., Mammu, S., V. H., N. C., & K. C., A. (2024). Impact of malnutrition on postoperative outcomes in total knee arthroplasty: a comprehensive analysis. International Journal of Research in Orthopaedics, 10(6), 1303–1311. https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20243127

Issue

Section

Original Research Articles