Introduction: Although the influence of preoperative nutritional status on short term outcome in arthroplasty is well known, its relationship with early prosthetic joint infection (EPJI) in total knee replacement remains unclear.
Aim: Our aim was to assess the effect of preoperative nutritional status on patients who went on to present with EPJI following total knee replacement surgery. This assessment was based on preoperative blood tests and anthropometric measurements.
Methods: A total of 213 patients undergoing total knee replacement between December 2007 and May 2008 were included in the study. Patients with rheumatoid arthritis were excluded. For each patient we pre-operatively checked haemoglobin level, CRP, ESR, total lymphocyte and protein count, albumin and pre-albumin concentration and triglicerids, cholesterol and creatinine levels. Triceps skindfold and arm/muscle circumference were measured the day before surgery. The body mass index was calculated based on the information contained in the anaesthetic chart. We also collected information about co-morbidities such as Diabetes, High blood pressure, ASA grading, age and gender. Information about early infections, both superficial and deep, was collected. A descriptive statistical analysis and logistic regression models approach for independent risk factors were performed.
Results: The mean age was 71.5 years. There were 162 female and 51 male. Eleven patients (5.16%) had early wound infection: 5 deep EPJI and 6 superficial. Neither co-morbidities nor preoperatively laboratory test except CRP (OR 1.44, p=0.03) were associated with a high early infection risk. However, there was an inversely proportional relationship between EPJI and anthropometric measurements: triceps skindfold (OR 0.9 p=0.011) and fat area (FA) (OR 0.94, p=0.01).
Conclusion: A low triceps skindfold and FA were associated with an increment of risk of EPJI after a knee replacement. Although the relationship between some laboratory test as pre-albumin and lymphocyte account and wound healing and postoperatively complications is well known, we didn’t find it with EPJI in our group except for CRP levels.
