Delayed wound healing and nutritional deficiencies after total hip arthroplasty

Ninety-two patients (103 hips) treated with total hip arthroplasty (THA) were assessed before and after operation to determine nutritional status and any correlation with delayed wound healing. Parameters indicative of nutritional status (serum albumin and serum transferrin) were assessed, along with immunologic and anthropometric parameters. Delayed wound healing complicated 34 of the 103 (33%) THAs. The preoperative serum transferrin levels were significantly lower for patients who subsequently developed wound-healing complications. Patients treated with single-stage, bilateral procedures had substantially lower postoperative serum transferrin and serum albumin levels and significantly higher incidences of delayed wound healing (64%) than patients who had single joint procedures (25%). Only preoperative serum transferrin levels showed significant value in predicting which patients would have delayed wound healing. None of the other serologic variables, including serum albumin and total lymphocyte count, proved to be a predictor of delayed wound healing. The preoperative assessment of three variables--serum transferrin value, bilateral procedure, and patient age--resulted in the correct prediction of wound healing outcome in 79% of the patients. This preoperative information, in combination with postoperative monitoring of serum transferrin and albumin levels, should alert the physician to the approach of a malnourished state. The malnourishment is attributable to heightened demands on the body's basal energy requirements after major orthopaedic surgery and can increase morbidity and prolong the hospital stay.