Protein-Energy Malnutrition as a Predictor of Early Recurrent Revisions After Debridement Surgery in Patients With Difficult-to-Treat Periprosthetic Infection
Background. Protein-energy malnutrition (PEM) is an established risk factor of postoperative complications in orthopedic disorders, including arthroplasty of the large joints. The study aimed to evaluate PEM prevalence and its association with the early postoperative revision in patients with the...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | Russian |
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Vreden Russian Research Institute of Traumatology and Orthopedics
2022-01-01
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| Series: | Travmatologiâ i Ortopediâ Rossii |
| Subjects: | |
| Online Access: | https://journal.rniito.org/jour/article/viewFile/1717/pdf |
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| author | Svetlana A. Bozhkova Vitaly N. Liventsov Rashid M. Tikhilov Carlo L. Romano Aleksandr Yu. Kochish Dmitry V. Labutin Vasily A. Artyukh |
| author_facet | Svetlana A. Bozhkova Vitaly N. Liventsov Rashid M. Tikhilov Carlo L. Romano Aleksandr Yu. Kochish Dmitry V. Labutin Vasily A. Artyukh |
| author_sort | Svetlana A. Bozhkova |
| collection | DOAJ |
| description | Background. Protein-energy malnutrition (PEM) is an established risk factor of postoperative complications in orthopedic disorders, including arthroplasty of the large joints.
The study aimed to evaluate PEM prevalence and its association with the early postoperative revision in patients with the difficult-to-treat (DTT) prosthetic joint infection (PJI) of the hip.
Methods. The retrospective study included 132 patients with chronic DTT PJI of the hip. The patients underwent orthopedic implant removal, radical debridement of the infected tissues, and resection arthroplasty with non-free transplantation of an axial vastus lateralis muscle flap (n = 57) or installation of an antimicrobial spacer (n = 75). DTT PJI was defined as an infection caused by rifampicin-resistant staphylococcal strains, ciprofloxacin-resistant gram-negative bacteria, fungi of the genus Candida, and their associations. The assessment of the patients protein-energy status included the evaluation of reference laboratory parameters, such as levels of hemoglobin, total protein, and albumin and number of lymphocytes. The degree of PEM was determined by the number of laboratory markers below the threshold values. The statistical comparison was performed using Fishers test. The odds ratio (OR, 95% confidence interval [CI]) was calculated to assess the risk of PJI recurrence. Differences were considered significant at p0.05.
Results. More than 70% of patients with chronic DTT PJI included in the study were diagnosed with preoperative PEM of varying degrees of severity. Hypoalbuminemia and decreased hemoglobin levels were diagnosed more often: 64.3% and 57.1% in the muscle flap plasty and 57.3% and 31.1% in the antimicrobial spacer group, respectively. In muscle plasty and antimicrobial spacer groups, a decrease in the values of three or more reference PEM markers was detected in 28.5% and 16.0% of patients, and this advanced impairment of the nutritional status increased the risk of early revision intervention by two (OR 2.0; CI 95% 0.478.56; p = 0.35) and six times (OR 6.11; 95% CI 1.0635.35; p0.04), respectively.
Conclusion. In general, the analysis of publications and results of our study show that PEM is associated with the development of surgical site infection and recurrence of PJI after revision surgery. A decrease in the values of three or more reference PEM markers is a significant predictor of repeated revisions after debridement surgery with the installation of an antimicrobial spacer. PEM complicates the postoperative course in patients with resection arthroplasty. Given the high incidence of PEM in patients with DTT PJI of the hip joint, further research is needed to develop methods for nutritional status correction and assessment of their effect on the outcomes of debridement surgery. |
| first_indexed | 2024-12-12T05:12:33Z |
| format | Article |
| id | doaj.art-2835745600b24258be2d002917496ba6 |
| institution | Directory Open Access Journal |
| issn | 2311-2905 2542-0933 |
| language | Russian |
| last_indexed | 2024-12-12T05:12:33Z |
| publishDate | 2022-01-01 |
| publisher | Vreden Russian Research Institute of Traumatology and Orthopedics |
| record_format | Article |
| series | Travmatologiâ i Ortopediâ Rossii |
| spelling | doaj.art-2835745600b24258be2d002917496ba62022-12-22T00:36:51ZrusVreden Russian Research Institute of Traumatology and OrthopedicsTravmatologiâ i Ortopediâ Rossii2311-29052542-09332022-01-01281394510.17816/2311-2905-17171025Protein-Energy Malnutrition as a Predictor of Early Recurrent Revisions After Debridement Surgery in Patients With Difficult-to-Treat Periprosthetic InfectionSvetlana A. Bozhkova0https://orcid.org/0000-0002-2083-2424Vitaly N. Liventsov1https://orcid.org/0000-0001-8748-2134Rashid M. Tikhilov2https://orcid.org/0000-0003-0733-2414Carlo L. Romano3https://orcid.org/0000-0001-6726-0593Aleksandr Yu. Kochish4https://orcid.org/0000-0002-2466-7120Dmitry V. Labutin5https://orcid.org/0000-0002-4405-7688Vasily A. Artyukh6https://orcid.org/0000-0002-5087-6081Vreden National Medical Research Center of Traumatology and OrthopedicsVreden National Medical Research Center of Traumatology and OrthopedicsVreden National Medical Research Center of Traumatology and OrthopedicsClinica San GaudenzioVreden National Medical Research Center of Traumatology and OrthopedicsVreden National Medical Research Center of Traumatology and OrthopedicsVreden National Medical Research Center of Traumatology and OrthopedicsBackground. Protein-energy malnutrition (PEM) is an established risk factor of postoperative complications in orthopedic disorders, including arthroplasty of the large joints. The study aimed to evaluate PEM prevalence and its association with the early postoperative revision in patients with the difficult-to-treat (DTT) prosthetic joint infection (PJI) of the hip. Methods. The retrospective study included 132 patients with chronic DTT PJI of the hip. The patients underwent orthopedic implant removal, radical debridement of the infected tissues, and resection arthroplasty with non-free transplantation of an axial vastus lateralis muscle flap (n = 57) or installation of an antimicrobial spacer (n = 75). DTT PJI was defined as an infection caused by rifampicin-resistant staphylococcal strains, ciprofloxacin-resistant gram-negative bacteria, fungi of the genus Candida, and their associations. The assessment of the patients protein-energy status included the evaluation of reference laboratory parameters, such as levels of hemoglobin, total protein, and albumin and number of lymphocytes. The degree of PEM was determined by the number of laboratory markers below the threshold values. The statistical comparison was performed using Fishers test. The odds ratio (OR, 95% confidence interval [CI]) was calculated to assess the risk of PJI recurrence. Differences were considered significant at p0.05. Results. More than 70% of patients with chronic DTT PJI included in the study were diagnosed with preoperative PEM of varying degrees of severity. Hypoalbuminemia and decreased hemoglobin levels were diagnosed more often: 64.3% and 57.1% in the muscle flap plasty and 57.3% and 31.1% in the antimicrobial spacer group, respectively. In muscle plasty and antimicrobial spacer groups, a decrease in the values of three or more reference PEM markers was detected in 28.5% and 16.0% of patients, and this advanced impairment of the nutritional status increased the risk of early revision intervention by two (OR 2.0; CI 95% 0.478.56; p = 0.35) and six times (OR 6.11; 95% CI 1.0635.35; p0.04), respectively. Conclusion. In general, the analysis of publications and results of our study show that PEM is associated with the development of surgical site infection and recurrence of PJI after revision surgery. A decrease in the values of three or more reference PEM markers is a significant predictor of repeated revisions after debridement surgery with the installation of an antimicrobial spacer. PEM complicates the postoperative course in patients with resection arthroplasty. Given the high incidence of PEM in patients with DTT PJI of the hip joint, further research is needed to develop methods for nutritional status correction and assessment of their effect on the outcomes of debridement surgery.https://journal.rniito.org/jour/article/viewFile/1717/pdfdifficult-to-treat infectionprosthetic joint infectionprotein-energy malnutritionhip resection arthroplasty |
| spellingShingle | Svetlana A. Bozhkova Vitaly N. Liventsov Rashid M. Tikhilov Carlo L. Romano Aleksandr Yu. Kochish Dmitry V. Labutin Vasily A. Artyukh Protein-Energy Malnutrition as a Predictor of Early Recurrent Revisions After Debridement Surgery in Patients With Difficult-to-Treat Periprosthetic Infection Travmatologiâ i Ortopediâ Rossii difficult-to-treat infection prosthetic joint infection protein-energy malnutrition hip resection arthroplasty |
| title | Protein-Energy Malnutrition as a Predictor of Early Recurrent Revisions After Debridement Surgery in Patients With Difficult-to-Treat Periprosthetic Infection |
| title_full | Protein-Energy Malnutrition as a Predictor of Early Recurrent Revisions After Debridement Surgery in Patients With Difficult-to-Treat Periprosthetic Infection |
| title_fullStr | Protein-Energy Malnutrition as a Predictor of Early Recurrent Revisions After Debridement Surgery in Patients With Difficult-to-Treat Periprosthetic Infection |
| title_full_unstemmed | Protein-Energy Malnutrition as a Predictor of Early Recurrent Revisions After Debridement Surgery in Patients With Difficult-to-Treat Periprosthetic Infection |
| title_short | Protein-Energy Malnutrition as a Predictor of Early Recurrent Revisions After Debridement Surgery in Patients With Difficult-to-Treat Periprosthetic Infection |
| title_sort | protein energy malnutrition as a predictor of early recurrent revisions after debridement surgery in patients with difficult to treat periprosthetic infection |
| topic | difficult-to-treat infection prosthetic joint infection protein-energy malnutrition hip resection arthroplasty |
| url | https://journal.rniito.org/jour/article/viewFile/1717/pdf |
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