August 08, 2025
3 min learn
Click on right here to learn the Cowl Story, “Vitamin could also be key to muscle, bone well being after surgical procedure.”
Don’t ignore vitamin
Regardless of vital developments in surgical approach, anesthesia and rehabilitation, dietary standing — an necessary contributor to outcomes after orthopedic surgical procedure — has been routinely missed till extra lately.
Malnutrition, notably within the type of sarcopenia and undernutrition, typically stays underdiagnosed and undertreated, but we’re more and more discovering it might have a measurable and modifiable influence on restoration.
Throughout a sequence of latest publications, my colleague, Matteo Briguglio, RDN, PhD, and I’ve described and demonstrated that dietary issues are extra prevalent in sufferers present process joint arthroplasty and backbone surgical procedure than may initially be thought. In our most up-to-date potential cohort of older adults present process complete hip arthroplasty, 43% had a dietary dysfunction at admission, resembling sarcopenia, undernutrition and mixtures thereof. On this cohort, dietary issues with lowered physique operate and reserves (sarcopenia and undernutrition) grounded a better vulnerability to surgical procedure by way of early stress response and short-term restoration. Apparently, the research additionally discovered that not one of the sufferers constantly coated their reference power and protein wants by weight loss program within the 10 days instantly post-surgery.
Tom Wainwright
These findings align with a broader physique of earlier surgical proof, the place malnutrition has been linked to elevated size of keep, larger complication charges, poorer bodily operate and better well being care prices. But, present preoperative evaluation typically depends on outdated or incomplete indicators, resembling BMI or serum albumin, which can fail to detect extra delicate, but clinically related, types of malnutrition. We now have argued that BMI alone is an insufficient threat stratifier. It can’t distinguish between fats and muscle mass, and inflexible cutoffs might inappropriately delay surgical procedure for sufferers who might in any other case profit from it. As an alternative, validated instruments, such because the International Management Initiative on Malnutrition standards alongside useful assessments and dietary screening, supply a extra exact and personalised method to threat identification.
Crucially, dietary issues are largely modifiable. Prehabilitation methods, together with protein and power supplementation, resistance coaching and tailor-made dietary training, are low-cost and possible interventions that may improve physiological resilience and enhance postoperative restoration. Our group has revealed frameworks that assist the sensible implementation of dietary care pathways inside orthopedic Enhanced Restoration After Surgical procedure applications.
It’s time to transfer past the outdated notion that vitamin is an ancillary concern. Dietary screening ought to be an ordinary part of preoperative care, and personalised interventions provided to these sufferers “at-risk” of suboptimal outcomes. As we proceed to optimize surgical pathways and search to speed up the useful restoration of sufferers, ignoring a affected person’s dietary readiness for restoration is more and more not an choice.
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For extra info:
Tom Wainwright, PhD, PT, is professor of orthopedics at Bournemouth College and marketing consultant physiotherapist at College Hospitals Dorset NHS Basis Belief in the UK. He might be contacted at twainwright@bournemouth.ac.uk.
Dietary screening is vital
Simply as no athlete would method a marathon with out cautious consideration to vitamin, sufferers shouldn’t enter orthopedic surgical procedure with out related preparation for the metabolic calls for of restoration.
Malnutrition is a silent but vital threat issue that may negatively influence outcomes after orthopedic surgical procedure, resembling complete joint arthroplasty. Preoperative malnutrition impacts an estimated 8.5% to 50% of sufferers present process elective TJA and is strongly related to elevated dangers for an infection, readmission, delayed therapeutic and mortality. Regardless of advances in perioperative care, nationwide information reveal a persistent burden of dietary deficits on this inhabitants.
Nicolas S. Piuzzi
A rising physique of proof helps the usage of goal laboratory markers — resembling serum albumin, prealbumin, transferrin and complete lymphocyte rely — alongside medical and anthropometric assessments to determine at-risk sufferers. Nevertheless, as a result of lack of a universally accepted screening device, a structured, multidisciplinary method is crucial. Efficient screening and intervention require collaboration amongst orthopedic surgeons, main care physicians, registered dietitians and perioperative care groups.
Importantly, dietary screening shouldn’t be merely about figuring out threat — it permits actionable, evidence-based interventions. Methods, resembling high-protein and anti inflammatory dietary regimens, have demonstrated advantages in postoperative restoration, even amongst sufferers not beforehand labeled as malnourished. To maximise their effectiveness, these interventions ought to ideally start no less than 4 weeks previous to surgical procedure, highlighting the necessity for well timed identification and training.
Fairly than viewing the ready interval earlier than elective surgical procedure as a delay, clinicians ought to reframe it as a worthwhile window for affected person optimization. This time might be strategically used to coach and information sufferers on dietary enhancements, strengthen interdisciplinary care coordination and enhance total readiness for surgical procedure.
Finally, vitamin is without doubt one of the most modifiable and impactful levers now we have to boost surgical outcomes. Integrating routine dietary screening and intervention into preoperative orthopedic care shouldn’t be non-compulsory. It’s a clinically significant motion that helps safer surgical procedure, quicker restoration and extra sturdy value-based care.
References:
Nicolas S. Piuzzi, MD, is vice chair of analysis within the division of orthopedic surgical procedure and director of Cleveland Clinic Grownup Reconstruction Analysis at Cleveland Clinic in Cleveland. He might be contacted by Grant Passel at passelg@ccf.org.
Sources/Disclosures
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Disclosures:
Wainwright studies no related monetary disclosures.Piuzzi studies receiving grants from NIH, Orthopaedic Analysis and Training Basis, Osteal Therapeutics, Peptilogics, Regen Lab, Signature Orthopaedics, Stryker and Zimmer Biomet; consulting charges from Ethicon Endo-Surgical procedure, Pacira BioSciences, Stryker and Zimmer Biomet; being a board or committee member for Journal of Bone and Joint Surgical procedure and Journal of Knee Surgical procedure; and having inventory or inventory choices with Osteal Therapeutics.
