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

Summary 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.