Sarcopenia Is Associated with an Increased Risk of Postoperative Complications Following Total Hip Arthroplasty for Osteoarthritis

Based on CT scans at the 12th thoracic spine level, assessing the impact of skeletal muscle and adipose tissue index on one-year postoperative mortality in elderly hip fracture patients: a propensity score-matched multicenter retrospective study

BACKGROUND

Research has demonstrated that individuals with sarcopenia or sarcopenic obesity who experience fractures or undergo major surgical interventions exhibit a poorer prognosis compared to the general population. However, few studies have investigated the relationship between the skeletal muscle and adipose tissue indices, as measured at the 12th thoracic spine level, and adverse outcomes following orthopedic surgery. Therefore, this study aimed to prove whether skeletal muscle and adipose tissue index measured by computed tomography (CT) images based on a single layer are associated with one-year postoperative mortality in elderly hip fracture patients.

METHODS

A total of 334 participants from two institutions were enrolled in this study to obtain skeletal muscle index (SMI), subcutaneous fat index (SFI), visceral fat index (VFI), and the visceral-to-subcutaneous ratio of the fat area (VSR) at T12 levels and divide them into death and survival groups based on the results of follow-up after 1 year. Propensity score matching (PSM) was employed to evaluate one-year postoperative mortality.

RESULTS

Institution 1's results identified that a lower SMI significantly heightened the risk of one-year postoperative mortality (OR = 0.799,95%CI 0.677-0.943, P = 0.008), making SMI an independent predictor. Institution 2's results identified that age (OR = 1.081, 95%CI 1.005-1.163, P = 0.036), SMI (OR = 0.881, 95%CI 0.784-0.991, P = 0.035) as independent predictors of one-year postoperative mortality in elderly hip fracture. Receiver operator characteristics analysis revealed area under the curve (AUC) values for institution 1: SMI (0.738 (95%CI 0.626-0.851), significant), VFI (0.605 (95%CI 0.476-0.734)), VSR (0.583 (95%CI 0.451-0.715)); and for institution 2: SMI (0.742 (95%CI 0.612-0.872), significant) and Age (0.775 (95%CI 0.677-0.874), significant). Collectively, these results underscore that SMI serves as an independent predictor of one-year postoperative mortality in elderly hip fracture patients.

CONCLUSION

This study demonstrated that the T12-based SMI was independently associated with one-year mortality following hip fracture in geriatric patients, with lower preoperative SMI correlating with higher mortality rates post-surgery.

Importance of hip capsular repair in total hip arthroplasty (THA) via the posterior lateral approach: a five year retrospective cohort study

PURPOSE

This study aims to assess the impact of repairing the hip joint capsule during posterior-lateral approach total hip arthroplasty (THA) on postoperative hip joint function and late dislocation incidence.

METHODS

A retrospective cohort study included 413 patients, divided into experimental (hip joint capsule repair, n = 204) and control (hip joint capsule excision, n = 209) groups. Patients were followed for five years, evaluating postoperative hip range of motion (ROM), dislocation rate, VAS and HHS scores, inflammatory and coagulation markers, hospitalization, blood loss, and body composition. Statistical analysis included the Student's t-test, Chi-square test, and logistic regression for dislocation risk factors.

RESULTS

Joint capsule repair improved postoperative hip flexion and extension within six months and at two years postoperatively, internal and external rotation within three months, and abduction and adduction throughout the entire follow-up period (P < 0.05). Capsular repair also reduced early and late dislocation rates (P < 0.05). Significant differences in HHS and VAS scores, inflammatory and coagulation indicators, hospitalization, blood loss, and body composition were noted (P < 0.05). Multivariate logistic regression indicated hip joint repair, rheumatoid arthritis, epilepsy, and sarcopenia as dislocation risk factors (P < 0.05).

CONCLUSIONS

Capsular repair during posterior-lateral THA improves postoperative hip function and mobility while reducing dislocation rates, blood loss, pain, inflammation, and economic burden. Patients with rheumatoid arthritis, epilepsy, or sarcopenia require individualized planning and enhanced postoperative care to minimize complications.

Implant-related and medical complications in patients with sarcopenia undergoing total shoulder arthroplasty: A retrospective matched-cohort analysis

Background

In the continually aging United States population, the number of patients with sarcopenia who undergo shoulder arthroplasty may concomitantly increase. This retrospective cohort study aims to evaluate the rates of short-term implant-related and medical complications following shoulder arthroplasty in patients with and without a recent diagnosis of sarcopenia.

Methods

An exact 1:3 matched analysis of 4177 patients was performed using the PearlDiver database. Multivariable logistic regression was used to compare complications, Kaplan-Meier failure analysis was used to compare the cumulative hospital readmission rates. Two-sample T-testing was used to compare the 90-day cost of care.

Results

Sarcopenic patients were significantly more likely to experience postoperative shoulder instability (odds ratio (OR) = 2.32, 95% confidence interval (CI), 1.21-4.39) and periprosthetic infection (OR = 3.83, 95% CI, 1.74-8.67) within 1 year of their arthroplasty. Sarcopenic patients were at 25% and 41% greater risk of emergency department presentation and hospital readmission 1-year post-arthroplasty, respectively. Ninty-day total costs were greater among sarcopenics ($16 112.23 vs. 10 679.58, p < 0.001).

Conclusion

These results are important for orthopaedic surgeons counselling patients with a low muscle mass on the potential for increased complications after undergoing a total shoulder arthroplasty procedure.

Plant proteins: are they a good alternative to animal proteins in older people?

PURPOSE OF REVIEW

This review provides the latest insight into the impact of consuming plant-based protein for older people.

RECENT FINDINGS

According to the latest data, a healthy diet rich in plant-based-protein-rich-food could promote healthy aging. This health effect is partly because of the amino acid composition of proteins, as well as to the important constituents such as fiber and bioactive compounds found in the matrix. Furthermore, even though animal protein is more effective at stimulating muscle protein synthesis, a high consumption of plant protein (beyond 31 g/day) appears to enhance physical performance and reduce the risk of frailty in older individuals.

SUMMARY

Recent literature highlights numerous health benefits for older people associated with a substantial intake of plant-based vs. animal-based protein, both in preventing and mitigating chronic age-related diseases and reducing the risk of all-cause mortality. However, a high intake of plant-based protein-rich products could pose risks of malnutrition and fiber-related intestinal intolerances. Further research is needed to assess the risk-benefit ratio of a high consumption of plant proteins in older individuals before we can make robust recommendations on how far animal proteins can be healthfully replaced with plant proteins.

Preoperative Sarcopenia Severity and Clinical Outcomes after Total Hip Arthroplasty

The outcome of total hip arthroplasty (THA) in patients with end-stage arthritis of the hip is associated with preoperative physical status. This study was performed to examine the relationship between the preoperative severity of sarcopenia and clinical outcomes after THA. This retrospective cohort study was performed among 306 consecutive patients (mean age: 63.7 ± 12.9 years, 222 women) undergoing THA at a university hospital. The severity of sarcopenia was determined based on the skeletal muscle mass index (SMI), handgrip strength, and gait speed according to the criteria of the Asian Working Group for Sarcopenia 2019. The severe sarcopenia prevalence rate was 10.6%. Severe sarcopenia was significantly associated with the risk of delayed functional recovery (adjusted odds ratio, 2.82; 95% confidence interval, 1.03-7.72; p = 0.043) compared with the non-sarcopenia group after adjusting for pre-existing risk factors, including preoperative hip function and physical activity. The addition of SMI, handgrip strength, and gait speed to the model for risk of functional recovery delay significantly increased the area under the receiver operating characteristic curve (p = 0.038). Severe sarcopenia was significantly associated with poorer hip function and patient-reported outcomes at 6 months after surgery compared with the non-sarcopenia group. Severe sarcopenia was adversely associated with postoperative clinical outcomes in patients undergoing THA.

[Advances in study of surgical approaches and MRI evaluation of total hip arthroplasty]

Objective

To review the research on different surgical approaches and MRI evaluation of total hip arthroplasty (THA), to clarify the possible muscle damage caused by different approaches, and to help clinicians avoid intraoperative muscle damage and identify the causes of certain muscle-related complications after operation.

Methods

The research literature on different surgical approaches and MRI evaluation of THA at home and abroad was extensively reviewed to summarize the MRI performance of the posterior approach, modified direct lateral approach, direct anterior approach, and minimally invasive anterolateral approach (also called Orthopadische Chirurgie Munchen approach).

Results

The traditional posterior approach mainly damages the short external rotator muscle group and increases the incidence of postoperative dislocation; the piriformis-keeping posterior approach significantly improves the quality of the pyriformis tendon in the postoperative period, but it may lead to damage to the intrapelvic portion of the piriformis muscle. The modified direct lateral approach mainly damages the gluteus medius muscle, which increases the risk of postoperative claudication. The direct anterior approach mainly damages the vastus tensoris muscle and may result in damage to the short external rotator muscle group and the muscles around the incision. The minimally invasive anterolateral approach primarily damages the superior gluteal nerve, which subsequently leads to denervation of the broad fascial tensor fasciae latae, and this approach may also result in injury to the gluteus medius and gluteus minimus muscles. The muscle damage status significantly affects prognosis, and the minimally invasive approach is more suitable for elderly patients.

Conclusion

MRI can clarify the different types of muscle damage caused by different surgical approaches. Minimally invasive approaches can reduce muscle damage and improve postoperative function compared with traditional approaches, and can benefit elderly patients more, but due to the small field, forcing to expand the surgical field will lead to unintended muscle damage and reduce postoperative function.

Impact of sarcopenia in elderly patients undergoing elective total hip arthroplasty on postoperative outcomes: a propensity score-matched study

OBJECTIVE

Frailty poses a crucial risk for postoperative complications in the elderly, with sarcopenia being a key component. The impact of sarcopenia on postoperative outcomes after total hip arthroplasty (THA) is still unclear. This study investigated the potential link between sarcopenia and postoperative outcomes among elderly THA patients.

METHODS

Totally 198 older patients were enrolled in this study. Sarcopenia in this group was determined by assessing the skeletal muscle index, which was measured using computed tomography at the 12th thoracic vertebra and analyzed semi-automatically with MATLAB R2020a. Propensity score matching (PSM) was employed to evaluate postoperative complications of grade II and above (POCIIs).

RESULTS

The variables balanced using PSM contained age, sex and comorbidities including hypertension, diabetes, hyperlipidemia and COPD. Before PSM, sarcopenic patients with reduced BMI (24.02 ± 0.24 vs. 27.11 ± 0.66, P < 0.001) showed higher POCIIs rates (48.31% vs. 15%, P = 0.009) and more walking-assisted discharge instances (85.96% vs. 60%, P = 0.017) compared with non-sarcopenia patients. After PSM, this group maintained reduced BMI (23.47 ± 0.85 vs. 27.11 ± 0.66, P = 0.002), with increased POCIIs rates (54.41% vs. 15%, P = 0.002) and heightened reliance on walking assistance at discharge (86.96% vs. 60%, P = 0.008).

CONCLUSION

Sarcopenia patients exhibited a higher incidence of POCIIs and poorer physical function at discharge. Sarcopenia could serve as a valuable prognostic indicator for elderly patients undergoing elective THA.

Knowledge, attitude, and practice regarding sarcopenia: a survey between orthopedic and geriatric professionals in China

BACKGROUND

In elderly patients with fractures, sarcopenia impairs recovery and even increases mortality. Both orthopedic and geriatric professionals are at the forefront of treating sarcopenic patients with fractures. However, it is not clear to what extent they have knowledge and skills to diagnose and treat sarcopenia.

AIMS

This study aimed to analyze and compare knowledge, attitude, and practice regarding sarcopenia between orthopedic and geriatric professionals.

METHODS

An online cross-sectional survey was conducted in June 2022 targeting professionals in orthopedic and geriatric departments in two largest tertiary general hospitals in Taizhou, southeastern China. Results on knowledge, attitude, and practice of sarcopenia were analyzed. Variables with significance were then included in a stepwise multiple linear regression analysis.

RESULTS

A total of 220 professionals, 176 from orthopedic departments and 44 from geriatric departments, participated in this study. Orthopedic professionals scored lower than geriatrics in knowledge, attitude and practice (P < 0.001). The attitude score was high in both orthopedic and geriatric professionals. Stepwise multiple linear regression analysis showed that participants who had contact with sarcopenia patients had higher knowledge score (β = 1.941, P < 0.001); participants who had attended sarcopenia training in the past 6 months (β = 4.305, P < 0.001) had higher practice score.

DISCUSSION

Orthopedic professionals have deficiencies in the screening and diagnosis of sarcopenia. Improving the knowledge and training of professionals can strengthen practice. It is necessary to formulate diagnostic criteria and improve practice of sarcopenia through training.

CONCLUSION

Orthopedic professionals had limited knowledge and practice regarding sarcopenia compared with geriatric professionals. To improve sarcopenia practice, the use of diagnostic tools to formally diagnose sarcopenia and regular training on sarcopenia should be encouraged.