The Archives of Bone and Joint Surgery

The Archives of Bone and Joint Surgery

Hypoalbuminemia Increases Mortality after Two-Stage Revision Total Joint Arthroplasty

Document Type : RESEARCH PAPER

Authors
Jonathan Guntin
Joseph Serino
David Rossi
Anthony Boniello
Charles A. Gusho
Craig J. Della Valle
Rush University Medical Center Department of Orthopedic Surgery, Chicago, IL, USA
10.22038/abjs.2022.65148.3123
Abstract
Objectives: This study aimed to evaluate the effect of hypoalbuminemia on failure rates and mortality
after a two-stage revision for PJI.
Methods: 199 Patients (130 knees and 69 hips) with a mean age of 64.7 ± 10.7 years who underwent a two-stage
exchange were retrospectively reviewed at a mean of 51.2 ± 39.7 months. Failure of treatment was defined as any
revision within the follow-up period, failure to undergo reimplantation, or death within one year of initiating treatment.
Results: There were 71 failures (35.7%), including 38 septic failures (19.1%). We found no differences between
successful revisions and failures regarding hypoalbuminemia (43% vs. 42% prior to stage 1, P=1 and 32% vs. 29%
prior to stage 2, P=0.856). There were also no differences in hypoalbuminemia rates between septic failures and
the rest of the cohort (42% vs. 43% prior to stage 1, P=1.0 and 34% vs. 30% prior to stage 2, P=0.674).
Hypoalbuminemia prior to stage 2 was a significant predictor of mortality based on multivariate analysis (odds ratio
5.40, CI 1.19-24.54, P=0.029). Hypoalbuminemia was independently associated with a greater length of stay by 2.2
days after stage 1 (P=0.002) and by 1.0 days after the second stage reimplantation (P=0.004).
Conclusion: Preoperative hypoalbuminemia is a significant predictor of mortality and increased length of stay
following two-stage revision but is not a predictor of failure of PJI treatment. Further study is required to understand
if hypoalbuminemia is a modifiable risk factor or a marker for poor outcomes.
Level of evidence: III
Keywords
Albumin
Hypoalbuminemia
Periprosthetic joint infection
Two-stage
Subjects
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  1. Botella-Carretero JI, Iglesias B, Balsa JA, Arrieta F, Zamarrón I, Vázquez C. Perioperative oral nutritional supplements in normally or mildly undernourished geriatric patients submitted to surgery for hip fracture: A randomized clinical trial. Clin Nutr. 2010; 29(5):574-579. doi:10.1016/j.clnu.2010.01.012
  2. Golladay GJ, Satpathy J, Jiranek WA. Patient Optimization-Strategies That Work: Malnutrition. J Arthroplasty. 2016; 31(8):1631-4. doi:10.1016/j.arth.2016.03.027
  3. Rao SS, Chaudhry YP, Solano MA, Sterling RS, Oni JK, Khanuja HS. Routine Preoperative Nutritional Screening in All Primary Total Joint Arthroplasty Patients Has Little Utility. J Arthroplasty. 2020; 35(12):3505-3511. doi:10.1016/j.arth.2020.06.073
  4. White JV, Guenter P, Jensen G, Malone A, Schofield M. Consensus Statement of the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition: Characteristics Recommended for the Identification and Documentation of Adult Malnutrition (Undernutrition). J Acad Nutr Diet. 2012; 112(5):730-738. doi:10.1016/j.jand.2012.03.012

 

The Archives of Bone and Joint Surgery
Volume 11, Issue 3
March 2023
Pages 173-179

  • Receive Date 29 April 2022
  • Revise Date 13 September 2022
  • Accept Date 15 September 2022