Perioperative Essential Amino Acid Supplementation Facilitates Quadriceps Muscle Strength and Volume Recovery After TKA: A Double-Blinded Randomized Controlled Trial

The dynamics of perioperative serum albumin before and after total knee arthroplasty

Background

Previous studies have evaluated preoperative serum albumin (SA) for predicting postoperative complications of total knee arthroplasty (TKA). This study aimed to investigate the dynamics of perioperative SA and changes in SA (ΔSA) and identify any influential patient or surgical factors.

Methods

In total, 381 patients (483 knees) undergoing primary TKA were recruited. SA values preoperatively (SA0), 1 week postoperatively (SA1W), and 4 weeks postoperatively (SA4W) were investigated. SA values were converted to a percentage of SA0 and differences between timepoints were calculated and expressed as follows: ΔSA1W-0, ΔSA4W-1W, and ΔSA4W-0. Patient and surgical factors previously identified or with the potential to influence SA were evaluated.

Results

The median values of SA0, SA1W, and SA4W were 4.4, 3.8, and 4.2 g/dL, respectively; SA0 was significantly different between groups (p < 0.001). The incidence of low SA0 (<3.5 g/dL) was less than 1 %. Median ΔSA values were -13.7 %, 9.6 %, and -4.5 % for ΔSA1W-0, ΔSA4W-1W and ΔSA4W-0, respectively; ΔSA was significantly different between groups (p < 0.001). SA4W recovered to 95.5 % of SA0 with less than 2 % of patients having low SA4W (<3.5 g/dL). Multiple regression analyses showed SA concentration at each timepoint was significantly associated with the other SA timepoint values; age was significantly associated with SA4W and SA1W (all p < 0.001).

Conclusions

We identified SA0 and age as significant factors affecting SA dynamics in the perioperative period. Low SA (<3.5 g/dL) was uncommon both preoperatively and at 4 weeks postoperatively; therefore, conventional cutoff values and preventive measures for low SA may need reconsideration.

Improved outcomes with perioperative dietitian-led interventions in patients undergoing total joint arthroplasty: A systematic review

Background

Nutritional assessment is important for optimization of patients undergoing elective total joint arthroplasty (TJA). Preoperative nutritional intervention is a potentially modifiable optimization target, but the outcomes of such intervention are not well-studied. The purpose of this study is to assess the impact of nutritional interventions on elective TJA outcomes.

Methods

Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were utilized to perform a systematic review of the Ovid Medline, Embase, and Cochrane Library systems. Included studies were comprised of patients greater than 18 years of age undergoing a primary unilateral TJA who received a perioperative dietitian-led intervention. Data analyzed included nutritional intervention protocol, patient demographics, length of stay (LOS), postoperative labs and complications, among others.

Results

Our initial search identified a total of 1766 articles. Four studies representing 5006 patients met inclusion criteria. The studies utilized a protein-dominant diet, with or without a carbohydrate solution accompanied by dietitian assessment or education. The 4 studies found that the intervention group had significantly decreased LOS, fewer albumin infusions, less wound drainage, lower rates of hypocalcemia and hypokalemia, reduced C-reactive protein (CRP) values, improved time out of bed, and decreased overall costs.

Conclusion

The findings support the potential benefits of perioperative dietitian-led intervention on key outcomes for patients undergoing primary TJA. Surgeons should consider nutritional intervention in their preoperative optimization protocols. Future studies could help elucidate the optimum nutritional regimens and monitoring for idealized intervention and surgical timing.

Prospero registration number

CRD4202338494.

Effects of essential amino acid (EAA) and glutamine supplementation on skeletal muscle wasting in acute, subacute, and postacute conditions

Under optimal physiological conditions, muscle mass maintenance is ensured by dietary protein, which balances the amino acid loss during the post-absorption period and preserves the body's protein homeostasis. Conversely, in critical clinical conditions (acute, subacute or postacute), particularly those related to hypomobility or immobility, combined with malnutrition, and local/systemic inflammation, the loss of muscle mass and strength can be quantitatively significant. A decline of more than 1% in muscle mass and of more than 3% in muscle strength has been registered in subjects with aged 20-37 yr after just five days of bed rest, similarly to those observed during one year of age-related decline in individuals over the age of 50. Loss of muscle mass and strength can have a dramatic effect on subjects' functional capacities, on their systemic metabolic control and on the amino acid reserve function, all of which are fundamental for the maintenance of other organs' and tissues' cell processes. References available indicate that the average 1%-2% reduction per day of muscle mass in patients in the intensive care unit (ICU) could represent an independent predictor of hospital mortality and physical disability in the five years following hospitalization. After just a few days or weeks of administration, supplementation with EAAs and glutamine has shown significant effects in maintaining muscle size and strength, which are typically negatively affected by some acute/subacute or postacute critical conditions (muscle recovery after surgery, oncology patients, ICU treatments), especially in the elderly or in those with pre-existing degenerative diseases. In this review, we focused on the theoretical bases and the most relevant clinical studies of EAA and glutamine supplementation as a single compound, with the aim of clarifying whether their combined use in a blend (EAAs-glutamine) could be potentially synergistic to prevent disease-related muscle wasting and its impact on the duration and quality of patients' clinical course.

Impact of nutrition on skin wound healing and aesthetic outcomes: A comprehensive narrative review

Background

While current wound treatment strategies often focus on antimicrobials and topical agents, the role of nutrition in wound healing and aesthetic outcomes is crucial but frequently overlooked. This review assesses the impact of specific nutrients and preoperative nutritional status on surgical outcomes.

Methods

A comprehensive search was conducted in PubMed, Scopus, Web of Science, and the Cochrane Library, from the inception of the study to October 2023. The study focused on the influence of macronutrients and micronutrients on aesthetic outcomes, the optimization of preoperative nutritional status, and the association between nutritional status and postoperative complications. Inclusion criteria were English language peer-reviewed articles, systematic reviews, meta-analyses, and clinical trials related to the impact of nutrition on skin wound healing and aesthetic outcomes. Exclusion criteria included non-English publications, non-peer-reviewed articles, opinion pieces, and animal studies.

Results

Omega-3 fatty acids and specific amino acids were linked to enhanced wound-healing and immune function. Vitamins A, B, and C and zinc positively influenced healing stages, while vitamin E showed variable results. Polyphenolic compounds showed anti-inflammatory effects beneficial for recovery. Malnutrition was associated with increased postoperative complications and infections, whereas preoperative nutritional support correlated with reduced hospital stays and complications.

Conclusion

Personalized nutritional plans are essential in surgical care, particularly for enhanced recovery after surgery protocols. Despite the demonstrated benefits of certain nutrients, gaps in research, particularly regarding elements such as iron, necessitate further studies. Nutritional assessments and interventions are vital for optimal preoperative care, underscoring the need for more comprehensive guidelines and research in nutritional management for surgical patients.

The Role of Amino Acid Supplementation in Orthopaedic Surgery

The nutritional status of patients undergoing orthopaedic surgery has started to garner increasing attention in published literature. Notable previous evidence has demonstrated the negative effect of malnutrition on outcomes after orthopaedic procedures. Although there has been increased recognition of malnutrition as a risk factor for suboptimal outcomes, the use of nutritional supplementation to mitigate those risks is not well understood. The purpose of this review of most current literature on the topic is to introduce and elucidate the role of amino acid supplementation as a countermeasure to muscle loss and improvement of nutritional status in orthopaedic patients to improve results and outcomes after orthopaedic surgery.

Increase in Postoperative Body Mass Index in Patients After Total Knee Arthroplasty

Objectives The aim of this is to investigate the changes in body mass index (BMI) following knee arthroplasty and to evaluate their impact on patient-reported outcomes and functional evaluations. Methods This observational study included 90 patients who underwent total knee arthroplasty (TKA) and were followed up for a median period of 2.6 years. BMI measurements were recorded before and after surgery, and patient-reported outcomes and functional evaluations were assessed using standardized scales and tests. Results Following TKA, BMI increased statistically significantly (Wilcoxon signed-rank test, p < 0.000). In addition, half of the patients experienced an increase in BMI, with 32% moving up in their BMI category. However, there were no clinically significant differences in patient-reported outcomes or functional evaluations between the group that gained BMI and the group that maintained or lost BMI. Conclusion This study reveals that patients tend to have increased BMI following TKA. However, these BMI changes do not significantly impact patient-reported outcomes or functional evaluations. It underscores the importance of patient education regarding healthy lifestyle habits, including diet and physical activity, to address postoperative weight gain effectively.