Hypoalbuminemia increases the risk of failure following one-stage septic revision for periprosthetic joint infection

Arch Orthop Trauma Surg. 2023 Sep;143(9):5641-5648. doi: 10.1007/s00402-023-04885-z. Epub 2023 Apr 18.

Abstract

Purpose: Malnutrition is a potentially modifiable risk factor of periprosthetic joint infection (PJI). The purpose of this study was to analyze the role of nutritional status as a risk factor for failure after one- stage revision hip or knee arthroplasty for PJI.

Methods: Retrospective, single-center, case-control study. Patients with PJI according to the 2018 International Consensus Meeting criteria were evaluated. Minimum follow-up was 4 years. Total lymphocyte count (TLC), albumin values, hemoglobin, C-reactive protein, white blood cell (WBC) count and glucose levels were analyzed. An analysis was also made of the index of malnutrition. Malnutrition was defined as serum albumin < 3.5 g/dL and TLC < 1500/mm3. Septic failure was defined as the presence of local or systemic symptoms of infection and the need of further surgery as a result of persistent PJI.

Results: No significant differences were found between increased failure rates after a one-stage revision hip or knee arthroplasty for PJI and TLC, hemoglobin level, WBC count, glucose levels, or malnutrition. Albumin and C-reactive protein values were found to have a positive and significant relationship with failure (p < 0.05). Multivariate logistic regression identified only hypoalbuminemia (serum albumin < 3.5 g/dL) (OR 5.64, 95% CI 1.26-25.18, p = 0.023) as a significant independent risk factor for failure. The receiver operating characteristic (ROC) curve for the model yielded an area under the curve of 0.67.

Conclusion: TLC, hemoglobin; WBC count; glucose levels; and malnutrition, understood as the combination of albumin and TLC, were not found to be statically significant risk factors for failure after single-stage revision for PJI. However, albumin < 3.5 g/dL, alone was a statically significant risk factor for failure after single-stage revision for PJI. As hypoalbuminemia seems to influence the failure rate, it is advisable to measure albumin levels in preoperative workups.

Keywords: Albumin; Malnutrition; Periprosthetic joint infection; Single–stage revision; Total lymphocyte count.

MeSH terms

  • Arthritis, Infectious* / surgery
  • Arthroplasty, Replacement, Hip* / adverse effects
  • C-Reactive Protein / analysis
  • Case-Control Studies
  • Glucose
  • Humans
  • Hypoalbuminemia* / complications
  • Hypoalbuminemia* / surgery
  • Malnutrition* / complications
  • Malnutrition* / surgery
  • Prosthesis-Related Infections* / diagnosis
  • Prosthesis-Related Infections* / etiology
  • Prosthesis-Related Infections* / surgery
  • Reoperation / adverse effects
  • Retrospective Studies
  • Serum Albumin / analysis

Substances

  • C-Reactive Protein
  • Serum Albumin
  • Glucose