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Abstract
BackgroundMalnutrition caused by protein and vitamin deficiencies is a significant negative prognostic factor in surgical wound healing disorders and infections. Particularly in elective surgery, preoperative compensation of deficiencies is advisable to avoid negative postoperative consequences. This study examined the nutritional and protein balance of patients with periprosthetic hip and knee joint infections.Material and methodsPatients with periprosthetic hip or knee joint infections constituted the study group (SG). Control group I (CG I) included patients with primary implants and CG II included patients who required revision surgery because of aseptic loosening. Relevant nutritional and protein parameters were determined via analysis of peripheral venous blood samples. In addition, a questionnaire was used to evaluate the nutritional and eating patterns of all patients. The nutritional risk screening (NRS) 2002 score and body mass index (BMI) were also calculated for all participants.ResultsDifferences were found in the albumin level (SG: 36.23 ± 7.34, CG I: 44.37 ± 3.32, p < 0.001, CG II: 44.06 ± 4.24, p < 0.001) and total protein in serum (SG: 65.42 ± 8.66, CG I: 70.80 ± 5.33, p = 0.004, CG II: 71.22 ± 5.21, p = 0.004). The number of patients with lowered albumin levels (SG 19/61, CG I 1/78, CG II 2/55) and total protein in serum (SG: 12/61, CG I 5/78, CG II 2/55) also showed considerable variation. The number of patients with a NRS 2002 score ≥3 differed significantly between SG and both CGs (SG: 5/61, CG I 1/78, CG II 0/55); however, these differences could not be confirmed using BMI.ConclusionAs expected, lowered albumin and total protein levels were observed in PJI due to the acute phase reaction. The NRS can be performed to exclude nutritional deficiency, which cannot be excluded based on BMI. In cases of periprosthetic joint infection it is reasonable to compensate the nutritional deficiency with dietary supplements.
Highlights
Despite the enormous progress in surgical treatment for reducing the risk of infections, periprosthetic joint infections (PJI) remain a major challenge and risk for the affected patients, the health system, and attending personnel [1,2,3,4]
According to the matching procedure both the CGI and II were adapted to the study group (SG) with respect to age, body mass index (BMI), and implant location (THA or total knee arthroplasty, TKA)
Malnutrition caused by protein and vitamin deficiencies is a significant negative prognostic factor in surgical wound healing disorders and infections
Summary
Despite the enormous progress in surgical treatment for reducing the risk of infections, periprosthetic joint infections (PJI) remain a major challenge and risk for the affected patients, the health system, and attending personnel [1,2,3,4]. The effects of nutritional status and protein balance are considered to be significant prognostic factors for the development of PJI [5, 6]. Low serum albumin level and protein deficiency are reportedly negative predictive factors with respect to the rates for perioperative and postoperative complications, such as PJI, associated with primary joint endoprostheses [15, 16]. It is striking that none of the cited studies took the importance of the nutritional status, the protein balance, into account. This retrospective analysis aimed to examine the nutritional status of and the protein balance in patients with periprosthetic hip and knee joint infections. Patients with primary endoprosthesis implantation and aseptic loosening constituted the comparison groups
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