DELAYED WOUND-HEALING AND NUTRITIONAL DEFICIENCIES AFTER TOTAL HIP-ARTHROPLASTY

Ninety-two patients (103 hips) treated with total hip arthroplasty (TH A) were assessed before and after operation to determine nutritional s tatus and any correlation with delayed wound healing. Parameters indic ative of nutritional status (serum albumin and serum transferrin) were assessed, along with immunologic and anthropometric parameters. Delay ed wound healing complicated 34 of the 103 (33%) THAs. The preoperativ e serum transferrin levels were significantly lower for patients who s ubsequently developed wound-healing complications. Patients treated wi th single-stage, bilateral procedures had substantially lower postoper ative serum transferrin and serum albumin levels and significantly hig her incidences of delayed wound healing (64%) than patients who had si ngle joint procedures (25%). Only preoperative serum transferrin level s showed significant value in predicting which patients would have del ayed wound healing. None of the other serologic variables, including s erum albumin and total lymphocyte count, proved to be a predictor of d elayed wound healing. The preoperative assessment of three variables-s erum transferrin value, bilateral procedure, and patient age-resulted in the correct prediction of wound healing outcome in 79% of the patie nts. This preoperative information, in combination with postoperative monitoring of serum transferrin and albumin levels, should alert the p hysician to the approach of a malnourished state. The malnourishment i s attributable to heightened demands on the body's basal energy requir ements after major orthopaedic surgery and can increase morbidity and prolong the hospital stay.