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Войти в исследования Journal of experimental orthopaedics · 2026
Nutritional disorders have adverse effect on clinical outcomes and may increase healthcare costs following hip and knee arthroplasty-A systematic review.
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Little Christopher David John, Ponniah Hariharan Subbiah, Ralhan Shvaita, Strickland Louise, Palmer Antony, Hamilton Thomas William
Аннотация
PURPOSE: To report the effect of nutritional disorder on outcomes following hip and knee arthroplasty using European Society of Clinical Nutrition and Metabolism (ESPEN) diagnostic criteria.
METHODS: A systematic review of level 1-4 evidence was conducted as per the PRISMA statement and Cochrane Handbook for Systematic Review (PROSPERO ID: CRD42023360517). In March 2024, AMED, CENTRAL, EMABASE, MEDLINE, Scopus and Web of Science were searched. Articles were included if they defined and reported the effect of nutritional disorder on outcome(s) of interest following hip and/or knee arthroplasty. Exclusion criteria were pathological fracture and <50 cases. The ROBINS-I was used to assess study bias. Data were presented with effect sizes if reported.
RESULTS: Fifty-eight studies were included (2,076,289 patients). Malnutrition, as per ESPEN criteria, increased mortality, post-op pain and length of hospital stay. Sarcopenia, diagnosed via computed tomography, increased surgical site infection rate following primary arthroplasty and mortality following hip fracture arthroplasty. Frailty worsened clinical outcomes following primary, revision and hip fracture arthroplasty. One included study reported healthcare cost; these were higher among frail patients undergoing primary total knee arthroplasty: $19,841 versus $6104, p = 0.001.
CONCLUSION: Nutritional disorder was associated with adverse clinical outcomes following primary, revision and hip fracture arthroplasty. Moderate-to-severe bias, heterogenous definitions of nutritional disorder and lack of standardised outcome reporting limited analyses, particularly analyses of healthcare costs which likely increase with nutritional disorder. Prospective study is required to examine potential for cost-saving and improved patient outcome following treatment of nutritional disorder in hip and knee arthroplasty populations.
LEVEL OF EVIDENCE: Level IV.
METHODS: A systematic review of level 1-4 evidence was conducted as per the PRISMA statement and Cochrane Handbook for Systematic Review (PROSPERO ID: CRD42023360517). In March 2024, AMED, CENTRAL, EMABASE, MEDLINE, Scopus and Web of Science were searched. Articles were included if they defined and reported the effect of nutritional disorder on outcome(s) of interest following hip and/or knee arthroplasty. Exclusion criteria were pathological fracture and <50 cases. The ROBINS-I was used to assess study bias. Data were presented with effect sizes if reported.
RESULTS: Fifty-eight studies were included (2,076,289 patients). Malnutrition, as per ESPEN criteria, increased mortality, post-op pain and length of hospital stay. Sarcopenia, diagnosed via computed tomography, increased surgical site infection rate following primary arthroplasty and mortality following hip fracture arthroplasty. Frailty worsened clinical outcomes following primary, revision and hip fracture arthroplasty. One included study reported healthcare cost; these were higher among frail patients undergoing primary total knee arthroplasty: $19,841 versus $6104, p = 0.001.
CONCLUSION: Nutritional disorder was associated with adverse clinical outcomes following primary, revision and hip fracture arthroplasty. Moderate-to-severe bias, heterogenous definitions of nutritional disorder and lack of standardised outcome reporting limited analyses, particularly analyses of healthcare costs which likely increase with nutritional disorder. Prospective study is required to examine potential for cost-saving and improved patient outcome following treatment of nutritional disorder in hip and knee arthroplasty populations.
LEVEL OF EVIDENCE: Level IV.