Association of Admission Nutritional Status Evaluated by the Controlling Nutritional Status Score with Periprosthetic Joint Infection after Primary Total Joint Arthroplasty: An Exploratory Analysis.
prospective_cohort · Level II
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- Record sourced from PubMed, PMID 41205715.
- Also identified by DOI 10.1016/j.arth.2025.10.121.
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Abstract
The relationship between admission malnutrition and periprosthetic joint infection (PJI) after total joint arthroplasty (TJA) remains unclear due to limited evidence. This study aimed to assess the association between admission nutritional status and PJI risk within one year after TJA. This exploratory analysis of the prospective collection of data from TJA patients was derived from a database of a tertiary orthopaedic referral center from October 1, 2014, to December 31, 2020, in China. Admission malnutrition is assessed by the Controlling Nutritional Status (CONUT) score. The main outcome was PJI, defined according to the 2014 Musculoskeletal Infection Society (MSIS) consensus criteria, determined by review of index hospitalization medical records, microbiology laboratory reports, and readmission records for PJI treatment within one year after discharge. A restricted cubic spline (RCS) was performed to visualize the dose-response relationship between the admission CONUT score and PJI risk. The Youden index was used to identify the optimal cut-off value. Propensity score matching and univariate conditional logistic regressions were used to evaluate the association of preoperative malnutrition with PJI risk. There were 10,775 patients included, with a PJI incidence of 1.01%. The RCS curve illustrated a significant positive correlation between the admission CONUT score and the risk of PJI (P-overall < 0.001). Admission malnutrition assessed by the CONUT score ≥ 3 was independently associated with a 70% increased risk of PJI (95% confidence interval [CI], 1.045 to 2.767; P = 0.033). Additionally, the results remain robust after inverse probability treatment weighting (IPTW) and sensitivity analysis. Admission malnutrition is an independent risk factor for PJI after TJA, and nutrition screening on admission is expected to aid admission counseling.