Abstract
Nutritional supplements can influence outcomes for individuals undergoing major surgery, particularly in older persons whose functional reserve is limited. Accelerating recovery from total hip replacement (THR) and total knee replacement (TKR) may offer significant benefits. Therefore, we explored the role of nutritional supplements in improving recovery following THR and TKR. A systematic review was conducted to source randomized clinical trials that tested nutritional supplements in cohorts of THR or TKR patients. Our search yielded nine relevant trials. Intake of a carbohydrate-containing fluid is reported to improve insulin-like growth factor levels, reduce hunger, nausea, and length of stay, and attenuate the decrease in whole-body insulin sensitivity and endogenous glucose release. Amino acid supplementation is reported to reduce muscle atrophy and accelerate return of functional mobility. One paper reported a suppressive effect of beta-hydroxy beta-methylbutyrate, l-arginine, and l-glutamine supplementation on muscle strength loss following TKR. There is limited evidence for nutritional supplementation in THR and TKR pathways; however, the low risk profile and potential benefits to adjunctive treatment methods, such as exercise programs, suggest nutritional supplements may have a role. Optimizing nutritional status pre-operatively may help manage the surgical stress response, with a particular benefit for undernourished, frail, or elderly individuals.
Highlights
With aging, nutrition plays a significant role in maintaining physical and cognitive abilities [1,2].nutritional status can influence post-operative outcomes for patients undergoing major surgery, in older persons whose functional reserve is limited [3]
We summarize and evaluate randomized clinical trials and pilot randomized clinical trials that investigated the role of oral nutritional supplementation in conjunction with total hip replacement (THR) and total knee replacement (TKR) surgeries
The results of our search (Table 3) show that, currently, there is very limited evidence upon which to make a recommendation on the use of nutritional supplements in THR and TKR
Summary
Nutritional status can influence post-operative outcomes for patients undergoing major surgery, in older persons whose functional reserve is limited [3]. Surgery is a stressful stimulus that results in a pro-catabolic hormonal and cytokine environment, which significantly impacts metabolism. This metabolic response is accompanied by high levels of oxidative stress, hyperinflammation, and immune system impairment, increasing the risk of post-operative complications [4]. Nutritional supplements are wide-ranging, and specific nutritional substrates can stimulate faster recovery by modulating the metabolic response after surgery [5]. Optimizing nutritional intake prior to surgery can be helpful for adjunctive treatment strategies, such as exercise, to be fully effective [6]
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