Nutritional considerations for postoperative recovery in orthopaedic surgeries

Authors

  • Priyank Sahoo Department of Orthopedics, DSP Main Hospital, Durgapur, West Bengal, India
  • Ananda Kisor Pal Department of Orthopedics, Jalpaiguri Government Medical College and Hospital, Jalpaiguri, West Bengal, India
  • Neha Agarwal Dr. Reddy’s Laboratories Limited, Hyderabad, Telangana, India
  • Priyanka Sadhukhan Department of Nutraceuticals, Dr. Reddy’s Laboratories Limited, Hyderabad, Telangana, India
  • Rachana Bhoite Department of Nutraceuticals, Dr. Reddy’s Laboratories Limited, Hyderabad, Telangana, India

DOI:

https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20254243

Keywords:

Orthopaedic surgery, Postoperative nutrition, Essential amino acids, Collagen, HMB

Abstract

India has witnessed a substantial increase in joint replacement surgeries over the past two decades. Despite surgical advances, suboptimal nutritional status remains a major determinant of poor postoperative outcomes, including delayed wound healing, muscle atrophy, and increased infection risk. Protein energy malnutrition (PEM) is a strong predictor of adverse outcomes and delayed wound healing. Supplementation with high quality protein, essential amino acids (EAAs), and β-hydroxy β-methylbutyrate (HMB) have demonstrated benefits in preserving muscle mass, promoting anabolic recovery and reducing postoperative complications. Emerging evidence suggests promising roles for collagen, hyaluronic acid, and plant-based nutraceuticals in orthopaedic recovery, though the extent of impact of these nutrients remain underexplored. Collagen peptides may enhance wound healing, connective tissue regeneration, and mitigate the relapse of osteoarthritis (OA). Hyaluronic acid, with its immunomodulatory and regenerative functions, shows potential in post-surgical tissue repair and symptom relief. Furthermore, plant-derived bioactives such as curcumin, Boswellia serrata, and palmitoylethanolamide (PEA) demonstrate anti-inflammatory and analgesic effects, offering alternatives to conventional NSAIDs with fewer adverse effects. This review evaluates the current evidence supporting perioperative nutritional strategies to enhance recovery following orthopaedic surgeries.

Metrics

Metrics Loading ...

References

Vaidya SV, Jogani AD, Pachore JA, Armstrong R, Vaidya CS. India Joining the World of Hip and Knee Registries: Present Status-A Leap Forward. Indian J Orthop. 2020;55(1):46-55. DOI: https://doi.org/10.1007/s43465-020-00251-y

Registry Data for Public. Indian Society of Hip and Knee Surgeons. Available at: https://www.ishks.com/ registry_public.html. Accessed on 20 March 2025.

Mi B, Xiong Y, Knoedler S, Alfertshofer M, Panayi AC, Wang H, et al. Ageing-related bone and immunity changes: insights into the complex interplay between the skeleton and the immune system. Bone Res. 2024;12(1):1-15. DOI: https://doi.org/10.1038/s41413-024-00346-4

Kim S, Won SJ, Lee NK, Chang CB. Life Expectancy of Patients Undergoing Total Knee Arthroplasty: Comparison With General Population. J Korean Med Sci. 2024;39(11):e106. DOI: https://doi.org/10.3346/jkms.2024.39.e106

Li X, Wang S, Liu W, Wu H, Zhu Y. Causal effect of physical activity and sedentary behaviors on the risk of osteoarthritis: a univariate and multivariate Mendelian randomization study. Sci Rep. 2023;13(1):19410. DOI: https://doi.org/10.1038/s41598-023-46984-2

Almeida PR, Mokete L, Sikhauli N, Mota A, Ndindwa B, Pietrzak JRT. Malnutrition in total joint arthroplasty: what should the orthopaedic surgeon consider? EFORT Open Rev. 2024;9(7):615-24. DOI: https://doi.org/10.1530/EOR-23-0192

Prakash M, Hippalgaonkar K, Reddy M, Seth A, Jayakumar T, Pranav Krishna B, et al. A Cross-Sectional Study on Patient Preferences for Selecting Surgeons for Joint Replacement Surgery in India. Cureus. 2024;16(7):e63836. DOI: https://doi.org/10.7759/cureus.63836

Harris AB, Lantieri MA, Agarwal AR, Golladay GJ, Thakkar SC. Osteoporosis and Total Knee Arthroplasty: Higher 5-Year Implant-Related Complications. J Arthroplasty. 2024;39(4):948-53.e1. DOI: https://doi.org/10.1016/j.arth.2023.10.045

Jiranek W. Modifiable Risk Factors in Total Joint Arthroplasty. J Arthroplasty. 2016;31(8):1619. DOI: https://doi.org/10.1016/j.arth.2016.06.017

Maier GS, Kolbow K, Lazovic D, Maus U. The Importance of Bone Mineral Density in Hip Arthroplasty: Results of a Survey Asking Orthopaedic Surgeons about Their Opinions and Attitudes Concerning Osteoporosis and Hip Arthroplasty. Adv Orthop. 2016;2016:8079354. DOI: https://doi.org/10.1155/2016/8079354

Black CS, Goltz DE, Ryan SP, Fletcher AN, Wellman SS, Bolognesi MP, et al. The Role of Malnutrition in Ninety-Day Outcomes After Total Joint Arthroplasty. J Arthroplasty. 2019;34(11):2594-600. DOI: https://doi.org/10.1016/j.arth.2019.05.060

Yi PH, Frank RM, Vann E, Sonn KA, Moric M, Della Valle CJ. Is Potential Malnutrition Associated With Septic Failure and Acute Infection After Revision Total Joint Arthroplasty? Clin Orthop Relat Res. 2015;473(1):175-82. DOI: https://doi.org/10.1007/s11999-014-3685-8

Ellsworth B, Kamath AF. Malnutrition and Total Joint Arthroplasty. J Nat Sci. 2016;2(3):e179.

Demling RH. Nutrition, Anabolism, and the Wound Healing Process: An Overview. Eplasty. 2009;9:e9.

Cartwright MM. The metabolic response to stress: a case of complex nutrition support management. Crit Care Nurs Clin North Am. 2004;16(4):467-87. DOI: https://doi.org/10.1016/S0899-5885(04)00070-X

Ljungqvist O. Jonathan E. Rhoads lecture 2011: Insulin resistance and enhanced recovery after surgery. JPEN J Parenter Enteral Nutr. 2012;36(4):389-98. DOI: https://doi.org/10.1177/0148607112445580

Gillis C, Carli F. Promoting Perioperative Metabolic and Nutritional Care. Anesthesiology. 2015;123(6):1455-72. DOI: https://doi.org/10.1097/ALN.0000000000000795

Curtis W, Choi T, Ahmad A, Shultz C. Perioperative Nutritional Considerations in Orthopaedic Surgery: A Review of the Literature. WJO. 2023;12(1):25-30.

Mbagwu C, Sloan M, Neuwirth AL, Charette RS, Baldwin KD, Kamath AF, et al. Preoperative Albumin, Transferrin, and Total Lymphocyte Count as Risk Markers for Postoperative Complications After Total Joint Arthroplasty: A Systematic Review. J Am Acad Orthop Surg Glob Res Rev. 2020;4(9):e19.00057. DOI: https://doi.org/10.5435/JAAOSGlobal-D-19-00057

Gu A, Malahias MA, Strigelli V, Nocon AA, Sculco TP, Sculco PK. Preoperative Malnutrition Negatively Correlates with Postoperative Wound Complications and Infection After Total Joint Arthroplasty: A Systematic Review and Meta-Analysis. J Arthroplasty. 2019;34(5):1013-24. DOI: https://doi.org/10.1016/j.arth.2019.01.005

Meyer M, Leiss F, Greimel F, Renkawitz T, Grifka J, Maderbacher G, et al. Impact of malnutrition and vitamin deficiency in geriatric patients undergoing orthopedic surgery. Acta Orthop. 2021;92(3):358-63. DOI: https://doi.org/10.1080/17453674.2021.1882092

Goncalves TJM, Goncalves SEAB, Nava N, Jorge VC, Okawa AM, Rocha VA, et al. Perioperative Immunonutrition in Elderly Patients Undergoing Total Hip and Knee Arthroplasty: Impact on Postoperative Outcomes. JPEN J Parenter Enteral Nutr. 2021;45(7):1559-66. DOI: https://doi.org/10.1002/jpen.2028

Bao L, Chu R, Zhang L, Li J, Yang H, Pang H. The impact of early nutritional support on postoperative wound healing in patients with complex fractures: A meta‐analysis review. Int Wound J. 2024;21(3):e14782. DOI: https://doi.org/10.1111/iwj.14782

Zink TM, Kent SE, Choudhary AN, Kavolus JJ. Nutrition in Surgery: An Orthopaedic Perspective. JBJS. 2023;105(23):1897. DOI: https://doi.org/10.2106/JBJS.23.00259

Hirsch KR, Wolfe RR, Ferrando AA. Pre- and Post-Surgical Nutrition for Preservation of Muscle Mass, Strength, and Functionality Following Orthopedic Surgery. Nutrients. 2021;13(5):1675. DOI: https://doi.org/10.3390/nu13051675

Weimann A, Braga M, Carli F, Higashiguchi T, Hubner M, Klek S, et al. ESPEN practical guideline: Clinical nutrition in surgery. Clin Nutr. 2021;40(7):4745-61. DOI: https://doi.org/10.1016/j.clnu.2021.03.031

George A, Holderread BM, Lambert BS, Harris JD, McCulloch PC. Post-operative protein supplementation following orthopaedic surgery: A systematic review. Sports Med Health Sci. 2023;6(1):16-24. DOI: https://doi.org/10.1016/j.smhs.2023.08.002

Arapovic AE, Nham FH, Darwiche H, El-Othmani M. Nutritional Considerations in Hip and Knee Arthroplasty: A Critical Analysis of Current Evidence. JBJS Reviews. 2024;12(8):e24.00033. DOI: https://doi.org/10.2106/JBJS.RVW.24.00033

Li M, Shi Q, Che X, Du X, Wang D, Song Y. Study of whey protein on muscle mass and functional rehabilitation in postoperative total knee arthroplasty patients. J Back Musculoskelet Rehabil. 2024;37(5):1381-90. DOI: https://doi.org/10.3233/BMR-240013

Ueyama H, Kanemoto N, Minoda Y, Taniguchi Y, Nakamura H. Perioperative Essential Amino Acid Supplementation Facilitates Quadriceps Muscle Strength and Volume Recovery After TKA: A Double-Blinded Randomized Controlled Trial. J Bone Joint Surg Am. 2023;105(5):345-53. DOI: https://doi.org/10.2106/JBJS.22.00675

Liao CD, Wu YT, Tsauo JY, Chen PR, Tu YK, Chen HC, et al. Effects of Protein Supplementation Combined with Exercise Training on Muscle Mass and Function in Older Adults with Lower-Extremity Osteoarthritis: A Systematic Review and Meta-Analysis of Randomized Trials. Nutrients. 2020;12(8):2422. DOI: https://doi.org/10.3390/nu12082422

Ueyama H, Kanemoto N, Minoda Y, Taniguchi Y, Nakamura H. 2020 Chitranjan S. Ranawat Award: Perioperative essential amino acid supplementation suppresses rectus femoris muscle atrophy and accelerates early functional recovery following total knee arthroplasty. Bone Joint J. 2020;102-B(6-A):10-8. DOI: https://doi.org/10.1302/0301-620X.102B6.BJJ-2019-1370.R1

Muyskens JB, Foote DM, Bigot NJ, Strycker LA, Smolkowski K, Kirkpatrick TK, et al. Cellular and morphological changes with EAA supplementation before and after total knee arthroplasty. J Appl Physiol (1985). 2019;127(2):531-45. DOI: https://doi.org/10.1152/japplphysiol.00869.2018

Leth MF, Bukhari S, Laursen CCW, Larsen ME, Tornoe AS, Jakobsen JC, et al. Risk of serious adverse events associated with non-steroidal anti-inflammatory drugs in orthopaedic surgery. A protocol for a systematic review. Acta Anaesthesiol Scand. 2022;66(10):1257-65. DOI: https://doi.org/10.1111/aas.14140

Jazayeri R, Anil U, Zuckerman JD. The Role of Amino Acid Supplementation in Orthopaedic Surgery. J Am Acad Orthop Surg. 2024;32(4):162-8. DOI: https://doi.org/10.5435/JAAOS-D-23-00300

Smith-Ryan AE, Hirsch KR, Saylor HE, Gould LM, Blue MNM. Nutritional Considerations and Strategies to Facilitate Injury Recovery and Rehabilitation. J Athl Train. 2020;55(9):918-30. DOI: https://doi.org/10.4085/1062-6050-550-19

Han Z, Ji NN, Ma JX, Dong Q, Ma XL. Effect of Resistance Training Combined with Beta-Hydroxy-Beta-Methylbutyric Acid Supplements in Elderly Patients with Sarcopenia after Hip Replacement. Orthop Surg. 2022;14(4):704-13. DOI: https://doi.org/10.1111/os.13208

Sanz-Paris A, Camprubi-Robles M, Lopez-Pedrosa JM, Pereira SL, Rueda R, Ballesteros-Pomar MD, et al. Role of Oral Nutritional Supplements Enriched with B-hydroxy-B-Methylbutyrate in Maintaining Muscle Function and Improving Clinical Outcomes in Various Clinical Settings. J Nutr Health Aging. 2018;22(6):664-75. DOI: https://doi.org/10.1007/s12603-018-0995-7

Wang H. A Review of the Effects of Collagen Treatment in Clinical Studies. Polymers. 2021;13(22):3868. DOI: https://doi.org/10.3390/polym13223868

Jorgensen LN, Kallehave F, Karlsmark T, Gottrup F. Reduced collagen accumulation after major surgery. Br J Surg. 1996;83(11):1591-4. DOI: https://doi.org/10.1002/bjs.1800831133

Postlethwaite AE, Seyer JM, Kang AH. Chemotactic attraction of human fibroblasts to type I, II, and III collagens and collagen-derived peptides. Proc Natl Acad Sci U S A. 1978;75(2):871-5. DOI: https://doi.org/10.1073/pnas.75.2.871

Shigemura Y, Iwai K, Morimatsu F, Iwamoto T, Mori T, Oda C, et al. Effect of Prolyl-hydroxyproline (Pro-Hyp), a food-derived collagen peptide in human blood, on growth of fibroblasts from mouse skin. J Agric Food Chem. 2009;57(2):444-9. DOI: https://doi.org/10.1021/jf802785h

Ohara H, Ichikawa S, Matsumoto H, Akiyama M, Fujimoto N, Kobayashi T, et al. Collagen-derived dipeptide, proline-hydroxyproline, stimulates cell proliferation and hyaluronic acid synthesis in cultured human dermal fibroblasts. J Dermatol. 2010;37(4):330-8. DOI: https://doi.org/10.1111/j.1346-8138.2010.00827.x

Hunt ER, Jacobs CA, Conley CEW, Ireland ML, Johnson DL, Lattermann C. Anterior cruciate ligament reconstruction reinitiates an inflammatory and chondrodegenerative process in the knee joint. J Orthop Res. 2021;39(6):1281-8. DOI: https://doi.org/10.1002/jor.24783

Khosravi G, Mahmodi Khaledi M, Abedi A, Azad Chehr MJ, Heidari MM. Inflammatory factors before and after orthopedic surgery in patients with fractures following trauma. Arch Trauma Res. 2022;11(4):184-8.

Lopez Vidriero E, Olive Vilas R, Lopez Capape D, Alonso Rodríguez J, Varela Sende L, Lopez Vidriero R, et al. Efficacy and Tolerability of a Dietary Supplement Containing Collagen, Hyaluronic Acid, Chondroitin Sulfate and Plasma Proteins in the Recovery After Anterior Cruciate Ligament Reconstruction. Orthop J Sports Med. 2018;6(6-3):2325967118S00040. DOI: https://doi.org/10.1177/2325967118S00040

Zhou Y, Zhang Y, Dai H, Zhang Y, Fu Y. The potential of undenatured type II collagen against arthritis: a review. Collagen Leather. 2024;6(1):17. DOI: https://doi.org/10.1186/s42825-024-00160-y

Ha CW, Park YB. Underestimation and undertreatment of osteoporosis in patients awaiting primary total knee arthroplasty. Arch Orthop Trauma Surg. 2020;140(8):1109-14. DOI: https://doi.org/10.1007/s00402-020-03462-y

Antoszewska M, Sokolewicz EM, Baranska-Rybak W. Wide Use of Hyaluronic Acid in the Process of Wound Healing-A Rapid Review. Scientia Pharmaceutica. 2024;92(2):23. DOI: https://doi.org/10.3390/scipharm92020023

Britteon P, Cullum N, Sutton M. Association between psychological health and wound complications after surgery. Br J Surg. 2017;104(6):769-76. DOI: https://doi.org/10.1002/bjs.10474

Guo S, DiPietro LA. Factors Affecting Wound Healing. J Dent Res. 2010;89(3):219-29. DOI: https://doi.org/10.1177/0022034509359125

Zeng L, Yang T, Yang K, Yu G, Li J, Xiang W, et al. Efficacy and Safety of Curcumin and Curcuma longa Extract in the Treatment of Arthritis: A Systematic Review and Meta-Analysis of Randomized Controlled Trial. Front Immunol. 2022;13:891822. DOI: https://doi.org/10.3389/fimmu.2022.891822

Zhao J, Liang G, Zhou G, Hong K, Yang W, Liu J, et al. Efficacy and safety of curcumin therapy for knee osteoarthritis: A Bayesian network meta-analysis. J Ethnopharmacol. 2024;321:117493. DOI: https://doi.org/10.1016/j.jep.2023.117493

Yu G, Xiang W, Zhang T, Zeng L, Yang K, Li J. Effectiveness of Boswellia and Boswellia extract for osteoarthritis patients: a systematic review and meta-analysis. BMC Complement Med Ther. 2020;20(1):225. DOI: https://doi.org/10.1186/s12906-020-02985-6

Majeed A, Majeed S, Satish G, Manjunatha R, Rabbani SN, Patil NVP, et al. A standardized Boswellia serrata extract shows improvements in knee osteoarthritis within five days-a double-blind, randomized, three-arm, parallel-group, multi-center, placebo-controlled trial. Front Pharmacol. 2024;15:1428440. DOI: https://doi.org/10.3389/fphar.2024.1428440

Ueberall M, Mueller-Schwefe G, Wigand R, Essner U. Efficacy, tolerability, and safety of an oral enzyme combination vs diclofenac in osteoarthritis of the knee: results of an individual patient-level pooled reanalysis of data from six randomized controlled trials. J Pain Res. 2016;9:941-61. DOI: https://doi.org/10.2147/JPR.S108563

Paladini A, Varrassi G, Bentivegna G, Carletti S, Piroli A, Coaccioli S. Palmitoylethanolamide in the Treatment of Failed Back Surgery Syndrome. Pain Res Treat. 2017;2017:1-6. DOI: https://doi.org/10.1155/2017/1486010

Steels E, Venkatesh R, Steels E, Vitetta G, Vitetta L. A double-blind randomized placebo controlled study assessing safety, tolerability and efficacy of palmitoylethanolamide for symptoms of knee osteoarthritis. Inflammopharmacology. 2019;27(3):475-85. DOI: https://doi.org/10.1007/s10787-019-00582-9

Downloads

Published

2025-12-26

How to Cite

Sahoo, P., Pal, A. K., Agarwal, N., Sadhukhan, P., & Bhoite, R. (2025). Nutritional considerations for postoperative recovery in orthopaedic surgeries. International Journal of Research in Orthopaedics, 12(1), 269–276. https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20254243

Issue

Section

Review Articles