Patient Malnourishment Hazard for Joint Replacement

Patients who are malnourished are more likely to have complications following total knee or hip replacement surgeries than patients who are morbidly obese. However, the researchers, led by P. Maxwell Courtney, M.D. of the Perelman School of Medicine at the University of Pennsylvania, found that, perhaps because of the amount of empty calories consumed, morbidly obese patients were more likely to be malnourished than were those who were simply obese.

The research team examined 670 patients who were undergoing total knee or hip replacement. Twelve percent of the patients were malnourished, while nearly 19% were morbidly obese. This was determined by a pre-operative body mass index greater than 40 mg/kg2.

Of the total patient population, 10% experienced a complication. When compared to patients with normal nutritional status, malnourished patients were nearly 20% more likely to have a postoperative complication. Thirteen percent were more likely to be readmitted within 90 days of discharge, and 12% were more likely to have an ICU admission following surgery. Five percent were more likely to require a return to the operating room.

Courtney, who presented his study results at the annual meeting of the American Academy of Orthopaedic Surgeons (AAOS) in Las Vegas, said, “These findings can lead to the development of clear guidelines to identify which patients need remediation before undergoing total knee or hip replacement. While it would be beneficial for morbidly obese patients to lose weight for better overall health, our findings indicate that doing so is not necessarily indicative of a post-op complication.”