Perioperative Nutritional Optimization in Total Joint Arthroplasty: From Screening to Supplementation

Malnutrition and suboptimal nutrient status are increasingly recognized as modifiable risk factors influencing outcomes after total joint arthroplasty (TJA). Older adults and medically complex patients are particularly vulnerable to perioperative catabolism, impaired wound healing, and delayed functional recovery. This review synthesized current evidence on perioperative nutritional optimization, including biochemical screening, micronutrient correction, essential amino acid (EAA) supplementation, and adjunctive metabolic strategies, to support recovery in patients undergoing total hip arthroplasty and total knee arthroplasty.

A targeted narrative literature review was performed using PubMed/MEDLINE and Google Scholar databases. Search terms included combinations of "total joint arthroplasty," "total knee arthroplasty," "total hip arthroplasty," "malnutrition," "albumin," "vitamin D," "vitamin C," "essential amino acids," "HMB," "arginine," "glutamine," "bioflavonoids," "micronized purified flavonoid fraction," "carbohydrate loading," and "GLP-1 receptor agonists." Priority was given to randomized controlled trials, systematic reviews, meta-analyses, and large observational studies with direct relevance to arthroplasty populations.

Vitamin D deficiency (13 to 63% of TJA patients) is consistently associated with increased complications, impaired functional scores, and higher infection risk, with favorable outcomes observed after targeted repletion. Vitamin C improves collagen synthesis, decreases inflammatory markers, reduces pain, and lowers the incidence of complex regional pain syndrome. Magnesium supports vitamin D activation, analgesia, and collagen stability. Bioflavonoids, particularly micronized purified flavonoid fraction, demonstrate high-quality evidence for reducing postoperative swelling and improving early motion after total knee arthroplasty. The use of EAA supplementation preserves quadriceps muscle mass, improves strength recovery, and accelerates return to activities of daily living. Carbohydrate loading mitigates postoperative insulin resistance, and glucagon-like peptide-1 receptor agonists offer metabolic benefits but require individualized perioperative management.

Perioperative nutritional optimization, including vitamin D repletion, vitamin C, magnesium support, micronized purified flavonoid fraction therapy, and structured EAA supplementation, represents a safe, accessible, and evidence-supported strategy to enhance recovery after TJA. Integrating targeted nutrition into prehabilitation pathways may help reduce complications and support faster functional gains.