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

Steven L Yee; R Cole Schmidt; James Satalich; John Krumme; Gregory J Golladay; Nirav K Patel

doi:10.1016/j.jor.2024.04.021

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

J Orthop. 2024 Apr 29:56:12-17. doi: 10.1016/j.jor.2024.04.021. eCollection 2024 Oct.

Authors

Steven L Yee¹, R Cole Schmidt², James Satalich², John Krumme³, Gregory J Golladay², Nirav K Patel⁴

Affiliations

¹ Virginia Commonwealth University School of Medicine, Richmond, VA, USA.
² Virginia Commonwealth University School of Medicine, Department of Orthopaedic Surgery, Richmond, VA, USA.
³ University of Missouri-Kansas City School of Medicine, Department of Orthopaedic Surgery, Kansas City, MO, USA.
⁴ Johns Hopkins University, Department of Orthopaedic Surgery, Bethesda, MD, USA.

PMID: 38737733
PMCID: PMC11081787 (available on 2025-10-01)
DOI: 10.1016/j.jor.2024.04.021

Abstract

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.

Keywords: Dietary intervention; Dietitian; Postoperative outcomes; Total joint arthroplasty.

Publication types

Review