The definitions and prevalence of nutritional disorders in hip and knee arthroplasty: A systematic review.
Little CDJ., Ponniah HS., Ralhan S., Strickland L., Palmer A., Hamilton TW.
PURPOSE: This systematic review aims to use European Society of Parenteral and Enteral Nutrition (ESPEN) terminology and diagnostic criteria to determine the prevalence of nutritional disorders in hip and knee arthroplasty. METHODS: A systematic review of Level 1-4 evidence was conducted as per the PRISMA statement and Cochrane handbook for Systematic Review (PROSPERO ID: CRD 42023360496). In March 2024, AMED, CENTRAL, EMBASE, MEDLINE, Scopus and Web of Science were searched. Articles were included if they defined and reported the prevalence of nutritional disorders in hip and knee arthroplasty populations. Exclusion criteria were subtrochanteric fracture, pathological fracture and <50 cases. The risk of bias in non-randomised studies of interventions and risk of bias 2 tools were used to assess bias. No pooled analyses were performed due to study heterogeneity. RESULTS: Fifty-five studies and 2,107,283 patients were included. Thirty-nine different definitions of nutritional disorder were identified. The prevalence of nutritional disorder varied depending on the chosen definition: 0.9%-71.7% in primary, 1.33%-47.5% in revision and 4.5%-60% in hip fracture arthroplasty. Thirty-four studies used albumin to diagnose malnutrition, with hypoalbuminaemia seen most frequently in hip fracture (20.3%-71.13%) and revision cohorts (2.5%-42.8%). No study reported the prevalence of sarcopenia in revision or hip fracture cohorts. CONCLUSION: All forms of nutritional disorder exist within hip and knee arthroplasty populations, particularly among revision and hip fracture patients. Included studies showed poor compliance with ESPEN recommendations and heterogeneity in the chosen definition of disorder. A prospective study using ESPEN-recommended diagnostic criteria is required to better determine the prevalence of nutritional disorders, contributing towards the understanding of the financial and patient-related costs following hip and knee arthroplasty. LEVEL OF EVIDENCE: Systematic review of articles with Level I-IV evidence.