Association of malnutrition with periprosthetic joint and surgical site infections after total joint arthroplasty: a systematic review and meta-analysis

A G Tsantes; D V Papadopoulos; T Lytras; A E Tsantes; A F Mavrogenis; A V Korompilias; I D Gelalis; C G Tsantes; S Bonovas

doi:10.1016/j.jhin.2019.04.020

Association of malnutrition with periprosthetic joint and surgical site infections after total joint arthroplasty: a systematic review and meta-analysis

J Hosp Infect. 2019 Sep;103(1):69-77. doi: 10.1016/j.jhin.2019.04.020. Epub 2019 May 3.

Authors

A G Tsantes¹, D V Papadopoulos², T Lytras³, A E Tsantes⁴, A F Mavrogenis⁵, A V Korompilias², I D Gelalis², C G Tsantes⁶, S Bonovas⁷

Affiliations

¹ First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, Attikon University Hospital, Athens, Greece. Electronic address: andreas.tsantes@yahoo.com.
² Department of Orthopedics, University of Ioannina, School of Medicine, University Hospital of Ioannina, Ioannina, Greece.
³ Hellenic Center for Disease Control and Prevention, Athens, Greece.
⁴ Laboratory of Haematology and Blood Bank Unit, National and Kapodistrian University of Athens, School of Medicine, Attikon University Hospital, Athens, Greece.
⁵ First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, Attikon University Hospital, Athens, Greece.
⁶ Technological Educational Institute of Crete, Department of Nutrition and Dietetics, Sitia, Greece.
⁷ Department of Biomedical Sciences, Humanitas University, Milan, Italy; Humanitas Clinical and Research Center, Milan, Italy.

PMID: 31054936
DOI: 10.1016/j.jhin.2019.04.020

Abstract

Background: A growing body of evidence associates malnutrition with several adverse outcomes.

Aim: To investigate the link between malnutrition with surgical site and periprosthetic joint infections (SSIs and PJIs) following total knee and hip arthroplasty (TKA and THA) through a comprehensive meta-analysis of observational studies.

Methods: A systematic search was conducted on PubMed and Scopus databases through December 2018, and recent proceedings of major orthopaedic meetings. Data from eligible studies were extracted and synthesized; pooled odds ratios (ORs) with 95% confidence intervals (CIs) were estimated.

Findings: Seven publications were included, reporting eight independent cohort studies with >250,000 subjects. SSIs and PJIs were more likely to develop in malnourished patients (OR: 2.49; 95% CI: 2.13-2.90; and 3.62; 2.33-5.64, respectively). The association of SSI with malnutrition was evident both after TKA (2.42; 1.94-3.02) and after THA (2.66; 1.64-4.30). Similarly, PJI was associated with malnutrition after TKA (2.55; 1.10-5.91) and after THA (3.10; 1.84-5.25). Finally, PJI correlated with malnutrition both after primary arthroplasty (3.58; 1.82-7.03) and revision arthroplasty (3.96; 2.47-6.33). The subgroup analysis by study setting confirmed the relationship between PJI and malnutrition in hospital (6.02; 3.07-11.81) and population-based (2.80; 1.76-4.44) studies.

Conclusion: Malnutrition is associated with PJIs and SSIs after total joint arthroplasty. Further high-quality research is warranted to confirm or refute these findings.

Keywords: Malnutrition; Periprosthetic joint infection; Surgical site infection; Total hip arthroplasty; Total knee arthroplasty.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Aged
Arthritis / epidemiology*
Arthroplasty, Replacement, Hip / adverse effects*
Arthroplasty, Replacement, Knee / adverse effects*
Cohort Studies
Female
Humans
Male
Malnutrition / complications*
Middle Aged
Prosthesis-Related Infections / epidemiology*
Surgical Wound Infection / epidemiology*