Preoperative serum albumin test may improve success of two-stage TJR exchange for PJI
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Due to low serum album levels in patients who undergo two-stage exchange for infected total joint replacement, a researcher recommended routinely testing the preoperative albumin level of patients indicated for this procedure.
To better elucidate the relationship between a patient’s nutritional status and PJI treatment success, investigators at OrthoCarolina retrospectively studied patients who underwent the first stage of two-stage revision for TJR infection with antibiotic spacer placement between 2014 and 2018. For inclusion in the study, all patients had 2-year minimum follow-up and needed test results for both serum albumin level and total lymphocyte count available in the 3 months prior to surgery.
“When serum albumin is less than 3.5 g/dL and serum total lymphocyte count is less than 1,500 cells/mm3, those are the two most commonly used definitions of malnutrition in the orthopedic literature,” Cody C. Green, MD, said at the Musculoskeletal Infection Society Annual Meeting, noting when these measurements are low there is increased risk of periprosthetic joint infection in primary and revision TJR.
Researchers sought to determine the relationship between treatment success after first-stage TJR exchange in planned two-stage exchange procedures for PJI and preoperative serum albumin levels and total leukocyte counts.
“Our failures were defined as a repeat surgery for infection after the first stage resection ... or the persistence of infection with conservative treatment,” Green said.
Following statistical analysis, “we had 168 patients included in our final analysis; 129 of those patients had low serum albumin or low total lymphocyte count and only 39 patients had normal nutrition,” he said.
Failure rates in the low serum albumin group were telling, according to Green, who said this group’s failure rate regarding treatment success was 46% vs. a 26% failure rate for patients with normal serum albumin, which was statistically significant.
“The total lymphocyte group did not have that same statistically significant difference. There was only a 46% failure rate vs. a 33% failure rate,” he said.
In the multivariate regression analysis, patients with low serum album were 4.2 times more likely to experience a failed first stage resection vs. patients with normal serum albumin, according to Green.
“This is the first study describing the association between low albumin and a failure to eradicate infection following first stage resection of a two-stage exchange for chronic PJI. Additional studies are needed to determine whether improving a patient’s low albumin may improve outcome following a two-stage exchange for chronic PJI, but we do recommend routine testing of preoperative serum albumin prior to first stage resection of a two-stage exchange for chronic PJI. It is then up to discretion of the treating surgeon to attempt correction of malnutrition or refer to a nutritionist for treatment prior to surgery.”
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Valenzuela M, et al. Paper 826. Presented at: Musculoskeletal Infection Society Annual Meeting; Aug. 6-7, 2021; Fort Lauderdale, Florida (hybrid meeting).
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