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

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. (C) 2019 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.