Authors: Yarbrough RK1, Gomez J2, King A1, Cantey JR2, Schutte HD1
Title: Infection is Associated with Malnutrition in Revision Arthorplasty patients
Addresses: Department of Orthopaedics1 and Division of Infectious Diseases2, Medical University of SC, Charleston, SC 29425
Purpose: Previous studies have documented the adverse effects of malnutrition on short term outcome in patients undergoing joint arthroplasty, including delayed wound healing, prolonged hospital stay and an overall increase in the post operative complication rate. The purpose of this study was to evaluate the incidence of malnutrition in revision arthroplasty patients.
Methods: Patients undergoing revision arthroplasty had nutritional status assessed preoperatively by measursement of prealbumin, transferrin and total lymphocyte count. A patient was defined as being malnourished if one of the following was present: prealbumin <16 mg/dl, transferrin <199 mg/dl, total lymphocyte count <1.5 mm3. The dataset was analyzed by Chi Square and Fisher's Exact Test as appropriate.
Results: One-hundred and forty patients with a mean age of 64 years who required revision of failed primary total joint arthroplasty were reviewed. The studied population included 63 total hip failures and 77 total knee failures. 58 patients were female and 82 male. 18 revisions were performed for infection (4 hips, 14 knees). 31% of non-infected patients versus 61% of infected patients had at least one abnormal nutritional parameter (p=0.015).
Discussion: Our data indicate that a high percentage of patients undergoing revision arthroplasty are malnourished. Interestingly, infected patients were at higher risk.
Significance: Preoperative malnutrition is associated with delayed wound healing, prolonged hospital stay and an overall increase in the postoperative complication rate in arthroplasty patients. Nutrtional parameters should be assessed and addressed in patients being considered for revision arthorplasty.