Nutritional considerations for postoperative recovery in orthopaedic surgeries
DOI:
https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20254243Keywords:
Orthopaedic surgery, Postoperative nutrition, Essential amino acids, Collagen, HMBAbstract
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.
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.
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.
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.
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.
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.
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.
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.
Jiranek W. Modifiable Risk Factors in Total Joint Arthroplasty. J Arthroplasty. 2016;31(8):1619.
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.
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.
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.
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.
Ljungqvist O. Jonathan E. Rhoads lecture 2011: Insulin resistance and enhanced recovery after surgery. JPEN J Parenter Enteral Nutr. 2012;36(4):389-98.
Gillis C, Carli F. Promoting Perioperative Metabolic and Nutritional Care. Anesthesiology. 2015;123(6):1455-72.
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.
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.
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.
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.
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.
Zink TM, Kent SE, Choudhary AN, Kavolus JJ. Nutrition in Surgery: An Orthopaedic Perspective. JBJS. 2023;105(23):1897.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Wang H. A Review of the Effects of Collagen Treatment in Clinical Studies. Polymers. 2021;13(22):3868.
Jorgensen LN, Kallehave F, Karlsmark T, Gottrup F. Reduced collagen accumulation after major surgery. Br J Surg. 1996;83(11):1591-4.
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.
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.
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.
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.
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.
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.
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.
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.
Britteon P, Cullum N, Sutton M. Association between psychological health and wound complications after surgery. Br J Surg. 2017;104(6):769-76.
Guo S, DiPietro LA. Factors Affecting Wound Healing. J Dent Res. 2010;89(3):219-29.
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.
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.
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.
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.
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.
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.
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.
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