Provision of high-protein supplement for patients recovering from hip fracture. Health-related quality of life and appropriateness of knee or hip joint replacement. Nutritional supplements after hip fracture: poor compliance limits effectiveness. Perioperative oral nutritional supplements in normally or mildly undernourished geriatric patients submitted to surgery for hip fracture: a randomized clinical trial. Clinical benefits of oral nutritional supplementation for elderly hip fracture patients: a single blind randomised controlled trial. Nutritional Supplementation Decreases Hip Fracture-related Complications Nutritional supplementation of elderly hip fracture patients. A randomized, double-blind, placebo-controlled trial. Effects of supplementation with a combination of β-hydroxy-β-methyl butyrate, L-arginine, and L-glutamine on postoperative recovery of quadriceps muscle strength after total knee arthroplasty. Predicting the cost-effectiveness of total hip and knee replacement: a health economic analysis. Effect of a Decision Aid on Access to Total Knee Replacement for Black Patients With Osteoarthritis of the Knee: A Randomized Clinical Trial Development of a decision aid to address racial disparities in utilization of knee replacement surgery. Nutritional status of elderly patients during recovery from chest infection and the role of nutritional supplementation assessed by a prospective randomized single-blind trial. Effects of oral nutritional supplements in normally nourished or mildly undernourished geriatric patients after surgery for hip fracture: a randomized clinical trial. A randomised controlled trial evaluating the use of enteral nutritional supplements postoperatively in malnourished surgical patients Effect of preoperative exercise on measures of functional status in men and women undergoing total hip and knee arthroplasty. A controlled trial of sip-feed supplements in elderly orthopaedic patients. Nightly Enteral Nutrition Support of Elderly Hip Fracture Patients: A Pilot Study
OBJECTIVE We compared clinical outcomes with a st and ard ( Ensure ) or a high-protein ( Boost HP ) liquid nutritional supplement for older adults recovering from hip fracture surgery in a rehabilitation hospital . METHODS This r and omized , double-blind , parallel-group study compared the clinical effectiveness of a st and ard ( Ensure ) with a high-protein ( Boost HP ) liquid nutritional supplement among patients ( n = 46 ) 60 y or older who recently underwent surgical repair of a hip fracture . Patients were encouraged to drink at least two 8-oz cans ( 17.8 g/d protein for Ensure versus 30 g/d protein for Boost HP ) per day for 28 d. Study measurements included change in Functional Independence Measure between rehabilitation admission and discharge , length of rehabilitation stay , laboratory measures ( i.e. , serum albumin , prealbumin , and C-reactive protein ) , physical activity energy expenditure by 7-d triaxial accelerometry , and dietary intake by three r and om , telephonic , 24-h dietary recalls . RESULTS There were no significant group differences with respect to age , sex , acute hospital days , hip fracture assessment parameters , or surgical treatment . Consumption of supplement ( 260 oz/28 d of Ensure versus 239 oz/28 d of Boost HP ) was comparable . There were no differences in complication or adverse event rates during the study . The Boost HP group consumed more protein than the Ensure group ( 63 versus 50 g , P < 0.048 ) and had a greater improvement in serum albumin over the 28-d supplementation period ( + 0.7 versus + 0.2 g/dL , P < 0.019 ) . The Boost HP group also consumed more fiber ( 12 versus 8 g ) , calcium ( 821 versus 639 mg ) , vitamin K ( 66 versus 45 microg ) , and phosphorus ( 1035 versus 833 mg ) than did the Ensure group . Rehabilitation length of stay was shorter in the Boost HP than in the Ensure group , although this trend did not reach statistical significance ( 23 versus 28 d , P = 0.27 ) . Outcome differences were not detected in the Functional Independence Measure . CONCLUSIONS Supplementation was well tolerated in this population and contributed significantly to total dietary intake . Consumption of a high-protein liquid nutritional supplement may offer some benefits by improving visceral protein status BACKGROUND We studied the association between explicit appropriateness criteria for total hip joint replacement ( THR ) and total knee replacement ( TKR )  with changes in health-related quality of life of patients undergoing these procedures . METHODS Prospect i ve observational study of 1576 consecutive patients with diagnoses of osteoarthritis on waiting lists to undergo THR or TKR . Explicit appropriateness criteria using the R AND appropriateness method were applied . Patients completed 2 question naires that measured health-related quality of life , the Medical Outcomes Study 36-Item Short-Form Health Survey ( SF-36 ) and the Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) , before the procedure and 6 months afterward . RESULTS Patients who were considered appropriate c and i date s for these procedures had greater improvements than those who were considered inappropriate c and i date s in all 3 WOMAC domains ( pain , functional limitation , and stiffness ; THR : 43.0 , 40.6 , and 40.4 vs 14.7 , 19.1 , and 15.9 ; TKR : 34.9 , 32.5 , and 30.2 vs 23.2 , 18.9 , and 17.1 ; P<.001 for all comparisons ) . Patients who underwent THR and were judged to be appropriate c and i date s had greater improvements in the physical function , role-physical , bodily pain , and social function domains of the SF-36 than those judged to be inappropriate c and i date s ( 34.4 , 35.1 , 33.1 , and 26.6 vs 19.6 , 9.2 , 5.7 , and 7.0 ; P = .04 , P = .03 , P < .001 , and P < .001 , respectively ) . Appropriate c and i date s for TKR demonstrated greater improvement in the social function domain of the SF-36 after the procedure than those deemed inappropriate c and i date s ( 19.9 vs 7.9 ; P = .004 ) but not in the other domains of functional status . CONCLUSIONS These results suggest a direct relationship between explicit appropriateness criteria and better health-related quality -of-life outcomes after THR and TKR surgery . Our results support the use of these criteria for clinical guidelines or evaluation purpose BACKGROUND Undernutrition and weight loss are important determinants of clinical outcome in older patients after hip fracture but the effectiveness of nutritional support programs in routine clinical practice remains controversial . AIMS OF THE PROJECT : To determine if oral nutritional supplements given daily for 28 days after hip fracture surgery could prevent weight loss and /or lead to improved clinical outcomes ( mortality rates , discharge destination , activities of daily living or length of hospital stay ) in non-malnourished community-dwelling older women with hip fracture . METHODS One hundred and nine women with BMI range 20 - 30 kg/m(2 ) were allocated to either nutritional supplements ( 352 kcal/day ) or usual hospital nutrition using a quasi-r and omisation technique . Body weight changes were monitored at 4 and 8 weeks and clinical outcomes were recorded at discharge and at 6 months . RESULTS No significant differences in weight change or clinical outcomes were seen between the two groups . Compliance with consuming the nutritional supplements was quite variable and there was a significant negative correlation between the amount of supplement consumed and subsequent weight change ( r=-0.36 , P=0.019 ) . CONCLUSIONS Poor compliance with oral nutritional supplements is an important determinant of the effectiveness of oral nutritional interventions in preventing weight loss after hip fracture . Whilst this may explain the lack of clinical improvements seen , our data do not support the routine use of oral nutritional supplements in non-malnourished hip fracture patients BACKGROUND Oral nutritional supplements have been recommended after orthopedic surgery in geriatric patients . This has been shown to be effective even in normally nourished or mildly undernourished geriatric patients . Whether perioperative administration of these products is also effective and suitable is not known . METHODS R and omized , controlled , open , paralleled two-arms clinical trial , comparing energy-protein supplements ( 40 g of protein and 400 kcal per day ) , with no intervention in normally nourished or mildly undernourished patients . Outcomes were serum proteins , body mass index , postoperative complications among others . RESULTS 60 Elderly patients were included . Patients in the intervention group ( n = 30 ) ingested 52.2 ± 12.1 % of the prescribed supplements per day for 5.8 ± 1.8 days before surgery and until hospital discharge . There was a significant change in serum albumin at follow-up ( F = 22.536 , P < 0.001 ) , and between the two groups ( F = 5.763 , P = 0.002 ) , favouring the intervention . The same was observed for serum prealbumin ( F = 6.654 , P = 0.001 within subjects , F = 2.865 , P = 0.045 for interaction ) . Logistic regression showed that only supplemented proteins per day ( OR[95%CI ] = 0.925[0.869 - 0.985 ] ) were associated with less postoperative complications ( R(2 ) = 0.323 , χ(2 ) = 11.541 , P = 0.003 ) . CONCLUSION Perioperative supplements in geriatric patients with hip fracture su bmi tted to surgery showed better recovery of plasma proteins . Higher daily protein intakes were associated with less postoperative complications BACKGROUND malnutrition is an important risk factor for poor outcome in patients recovering after hip fracture surgery . This study aim ed to investigate the clinical , nutritional and rehabilitation effects of an oral nutritional supplementation ( ONS ) in an inpatient rehabilitation setting . METHODS this was an observer-blinded r and omised controlled trial of elderly post-surgical proximal femoral fracture patients . A ready-to-use oral liquid nutritional supplementation ( 18 - 24 g protein and 500 kcal per day ) in addition to hospital diet was compared with hospital diet only . Both groups received usual rehabilitation therapy and oral calcium and vitamin D supplements . Outcomes were compared at discharge from rehabilitation and after 4 weeks of discharge . The primary outcome parameters were the serum albumin level , the body mass index ( BMI ) , the functional independence measure ( FIM ) and the elderly mobility scale ( EMS ) . Secondary outcome parameters were frequency of complications , inpatient length of stay , mortality and acute hospital use within 6 months after discharge . RESULTS a total of 126 patients were recruited , 65 in the supplementation arm and 61 in the control arm . There was a significant difference in change in BMI with a decrease of 0.25 and 0.03 kg/m(2 ) in the ONS group and 0.72 and 0.49 kg/m(2 ) in the control group at hospital discharge and follow-up , respectively ( P = 0.012 ) . The length of stay in rehabilitation ward was shortened by 3.80 ( SE = 1.81 , P = 0.04 ) days favouring the ONS group . The total number of infection episodes was also reduced significantly . No difference was observed in the rate of change of the serum albumin level , the FIM and the EMS . CONCLUSION clinical and nutritional benefits were seen in this trial but rehabilitation benefits could not be demonstrated Protein energy malnutrition is an important determinant of clinical outcome in older patients after hip fracture , but the effectiveness of nutritional support programs in routine clinical practice is controversial . We performed a prospect i ve , r and omized , controlled clinical trial to determine if nutritional supplementation decreased fracture-related complications in a selection of otherwise healthy patients with hip fractures . Patients were r and omized to intervention or control groups . The control group ( n = 40 ) was given ordinary hospital food and beverage . The intervention group ( n = 40 ) also was administered a 1000 kcal daily intravenous supplement for 3 days , followed by a 400 kcal oral nutritional supplement for 7 days . We recorded daily fluid and energy intake during the first 10 days of hospitalization and fracture-related complications up to 4 months . The total fluid and energy intake in the intervention group neared optimal levels . The control group received 54 % and 64 % of optimal energy and fluid intake , respectively . The risk of fracture- related complications was greater in the control group ( 70 % ) than in the intervention group ( 15 % ) . Four patients in the control group died within 120 days postoperatively . The comprehensive balanced nutrition supplement result ed in lower complication rates and mortality at 120 days postoperatively . Level of Evidence : Therapeutic Level I. See the Guidelines for Authors for a complete description of levels of evidence BACKGROUND undernourishment is common in elderly hip fracture patients and has been linked to poorer recovery and increased post-operative complications . OBJECTIVE to determine whether a nutritional supplement may ( i ) help elderly patients return to pre-fracture functional levels 6 months post-fracture and ( ii ) decrease fracture-related complications and mortality . DESIGN a double-blind , r and omized , placebo-controlled clinical trial . SETTING a county hospital near Barcelona . SUBJECTS 171 patients , aged 70 and older , hospitalized for hip fracture between July 1994 and July 1996 . METHODS we r and omized patients to intervention ( n = 85 ) or control ( n = 86 ) group . Patients received a nutritional supplement containing 20 g of protein and 800 mg of calcium or placebo for 60 days . We determined functional levels by the Barthel index , the mobility index and by the use of walking aids . We performed assessment s during hospitalization and at 2 and 6 months post-fracture . FINDINGS the two groups were comparable at study entry . We observed no differences in return to functional status 6 months post-fracture ( 61 % intervention group vs 55 % in control group ) nor in fracture-related mortality ( 13 % in intervention group vs 10 % in control group ) . The intervention group suffered fewer in-hospital [ odds ratio 1.88 ( 95 % CI 1.01 - 3.53 ) , P = 0.05 ] and total complications [ odds ratio 1.94 ( 95 % CI 1.02 - 3.7 ) , P = 0.04 ] than the control group . CONCLUSION based on our results , we can not recommend routine nutritional supplementation of all elderly hip fracture patients . While nutritional supplementation may be useful in decreasing complications , this reduction does not result in improvement in functional recovery and nor does it decrease fracture-related mortality . Selected patients may , however , benefit from nutritional supplementation OBJECTIVES Total knee arthroplasty ( TKA ) performed in knee osteoarthritis patients is reported to be immediately followed by a decrease in quadriceps muscle strength . We investigated the effects of supplementation with a combination β-hydroxy-β-methyl butyrate , L-arginine , and L-glutamine ( HMB/Arg/Gln ) on the postoperative recovery of quadriceps muscle strength in patients after TKA . METHODS Study subjects were 23 patients ( 12 women ; mean age : 70.5 ) who underwent TKA . The patients were r and omly allocated into the control group or the group that consumed HMB/Arg/Gln supplementation ( HMB/Arg/Gln group ) . HMB/Arg/Gln supplementation or control food were consumed for 5 days before the surgery and for 28 days after the surgery , and maximal quadriceps strength was measured at 7 days before the surgery , and at 14 , 28 and 42 days after the surgery . During the study , total energy expenditure was measured using a lifestyle recording device . The two groups followed the rehabilitation in the same way . RESULTS The maximal quadriceps strength was 1.1±0.62 Nm/Kg before surgery and 0.7±0.9 Nm/Kg after surgery 14 days in the control group ( p=0.02 ) , and 1.1±0.3 Nm/Kg before surgery and 0.9±0.4 Nm/Kg after surgery 14 days in the HMB/Arg/Gln group . Although the control group experienced a significant loss of muscle strength after the surgery , the HMB/Arg/Gln group did not . There was no significant difference in total energy expenditure between the two groups . CONCLUSIONS Consuming HMB/Arg/Gln supplementation may suppress the loss of muscle strength after TKA . Intervention with exercise and nutrition appears to enable patients to maintain their quadriceps strength The aim of this study was to perform a cost-utility analysis of  total hip ( THR ) and knee replacement ( TKR ) .  Arthritis is a disabling condition that leads to long-term deterioration in quality of life . Total joint replacement , despite being one of the greatest advances in medicine of the modern era , has recently come under scrutiny . The National Health Service ( NHS ) has competing dem and s , and re source allocation is challenging in times of economic restraint . Patients who underwent THR ( n = 348 ) or TKR ( n = 323 ) between January and July 2010 in one Scottish region were entered into a prospect i ve arthroplasty data base . A health-utility score was derived from the EuroQol ( EQ-5D ) score pre-operatively and at one year , and was combined with individual life expectancy to derive the quality -adjusted life years ( QALYs ) gained . Two-way analysis of variance was used to compare QALYs gained between procedures , while controlling for baseline differences . The number of QALYs gained was higher after THR than after TKR ( 6.5 vs 4.0 years , p < 0.001 ) . The cost per QALY for THR was £ 1372 compared with £ 2101 for TKR . The predictors of an increase in QALYs gained were poorer health before surgery ( p < 0.001 ) and younger age ( p < 0.001 ) . General health ( EQ-5D VAS ) showed greater improvement after THR than after TKR ( p < 0.001 ) . This study provides up-to- date cost-effectiveness data for total joint replacement . THR and TKR are extremely effective both clinical ly and in terms of cost effectiveness , with costs that compare favourably to those of other medical interventions Importance Black patients with advanced osteoarthritis ( OA ) of the knee are significantly less likely than white patients to undergo surgery . No strategies have been proved to improve access to surgery for black patients with end-stage OA of the knee . Objective To assess whether a decision aid improves access to total knee replacement ( TKR ) surgery for black patients with OA of the knee . Design , Setting , and Participants In a r and omized clinical trial , 336 eligible participants who self-identified as black and 50 years or older with chronic and frequent knee pain , a Western Ontario McMaster Universities Osteoarthritis Index score of at least 39 , and radiographic evidence of OA of the knee were recruited from December 1 , 2010 , to May 31 , 2014 , at 3 medical centers . Exclusion criteria were history of major joint replacement , terminal illness , inflammatory arthritis , prosthetic leg , cognitive impairment , lack of a telephone , or contraindications to elective replacement surgery . Data were analyzed on a per- protocol and intention-to-treat ( ITT ) basis . Exposure Access to a decision aid for OA of the knee , a 40-minute video that describes the risks and benefits of TKR surgery . Main Outcomes and Measures Receipt of TKR surgery within 12 months and /or a recommendation for TKR surgery from an orthopedic surgeon within 6 months after the intervention . Results Among 336 patients ( 101 men [ 30.1 % ] ; 235 women [ 69.9 % ] ; mean [ SD ] age , 59.1 [ 7.2 ] years ) r and omized to the intervention or control group , 13 of 168 controls ( 7.7 % ) and 25 of 168 intervention patients ( 14.9 % ) underwent TKR within 12 months ( P = .04 ) . These changes represent a 70 % increase in the TKR rate , which increased by 86 % ( 11 of 154 [ 7.1 % ] vs 23 of 150 [ 15.3 % ] ; P = .02 ) in the per- protocol sample . Twenty-six controls ( 15.5 % ) and 34 intervention patients ( 20.2 % ) in the ITT analysis received a recommendation for surgery within 6 months ( P = .25 ) . The difference in the surgery recommendation rate between the controls ( 24 of 154 [ 15.6 % ] ) and the intervention group ( 31 of 150 [ 20.7 % ] ) in the per- protocol analysis also was not statistically significant ( P = .25 ) . Adjustment for study site yielded similar results : for receipt of TKR at 12 months , adjusted ORs were 2.10 ( 95 % CI , 1.04 - 4.27 ) for the ITT analysis and 2.39 ( 95 % CI , 1.12 - 5.10 ) for the per- protocol analysis ; for recommendation of TKR at 6 months , 1.39 ( 95 % CI , 0.79 - 2.44 ) and 1.41 ( 95 % CI , 0.78 - 2.55 ) . Conclusions and Relevance A decision aid increased rates of TKR  among black patients . However , rates of recommendation for surgery did not differ significantly . A patient-centered counseling and educational intervention may help to address racial variations in the use of TKR for the management of end-stage OA of the knee . Trial Registration clinical trials.gov Identifer : OBJECTIVE Previous studies suggest that poorer knowledge and expectations about surgical outcomes may be responsible for low rates of total knee replacement ( TKR ) among African American males . The goal of this study was to pilot test the scope , acceptability , and efficacy of an educational videotape and tailored TKR decision aid design ed to reduce disparities in TKR knowledge and expectations . METHODS African American and Caucasian male veteran volunteers ages 55 - 85 years with moderate to severe knee osteoarthritis ( OA ) were recruited . During group meetings , patients viewed a video about knee OA treatments and were provided a personalized arthritis report that presented predicted patient outcomes should they decide to undergo TKR . Patients completed baseline and postintervention question naires that included an adapted Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) instrument to measure post-TKR expectations ( 0 - 100 scale with higher scores reflecting poorer outcomes ) . RESULTS A total of 102 patients ( 54 African American , 48 Caucasian ) completed the baseline survey and 64 patients attended the intervention . There were no significant differences by race between patients completing and those dropping out of the study . At baseline ( n = 102 ) , African American patients expressed lower expectations about post-TKR outcomes than did Caucasian patients for both pain ( WOMAC score 41 versus 34 ; P = 0.18 ) and physical function expectations ( WOMAC score 38 versus 30 ; P = 0.13 ) . Among African Americans who underwent the intervention , expected pain and physical function improved to 31 ( P = 0.04 versus baseline ) and 30 ( P = 0.09 versus baseline ) , respectively . Caucasian patients ' expectations changed little . CONCLUSION Disparities in baseline knowledge and expectations about TKR may be improved with the combined educational video and tailored decision aid We examined changes in the nutritional status of elderly patients with chest infection for a period of 3 months after discharge from hospital , including the effects of nutritional supplementation on well-being and functional status as well as on nutritional indices . Eighty-one subjects admitted to an acute medical ward aged 65 years and over with chest infection were recruited consecutively , and r and omized to receive supplement ( 500 ml of Ensure liquid daily ) for 1 month , or no supplement , on discharge . Assessment at baseline , 1 , 2 and 3 months included a question naire to determine health , mental and functional status , and anthropometric measurements . Biochemical nutritional status was assessed at baseline , 1 and 3 months , and  dietary intake  ( 24 h recall method ) at 1 and 3 months . During recovery , both supplement and non-supplement groups showed improvement in various measures of well-being and biochemical status . In addition , the former group showed improvement in more anthropometric measurements , in thiamine and pyridoxine status , while the non-supplement group showed a lower level of functional ability after 3 months . Various measures of well-being and biochemical status of the water-soluble vitamins were better in the supplement groups . We conclude that nutritional supplementation may have a role in helping elderly patients to recover from chest infections BACKGROUND Oral nutritional supplements have been recommended after orthopedic surgery in geriatric patients to reduce postoperative complications . However , tolerability of supplements could be a limitation , and their universal use is not supported by the heterogeneity of previous studies , especially in patients without malnutrition . METHODS This study is a r and omized , controlled , open , parallel , 3-arm clinical trial comparing supplementation with protein powder dissolved in liquids to aim at 36 g of protein per day , energy and protein supplements to aim at 37.6 g of protein and 500 kcal per day , or no intervention in normally nourished or mildly undernourished patients . Outcomes were serum albumin , prealbumin , retinol-binding globulin , and body mass index , among others . Postoperative complications were also recorded . RESULTS Ninety patients aged 83.8 + /- 6.6 years were included . The mean ingested amount of supplements was 41.1 % + /- 20.6 % in the protein powder supplement group and 51.4 % + /- 13.2 % in the energy protein supplement group ( t = 2.278 , P = .027 ) . Postoperative supplements had no effect on the nutrition status during in-hospital follow-up , as assessed by serum albumin ( P = .251 ) , prealbumin ( P = .530 ) , retinol-binding globulin ( P = .552 ) , or body mass index ( P = .582 ) . Multivariate analysis showed that length of hospital stay with an established complication until its resolution ( beta = .230 , P = .031 ) , total hospital stay ( beta = .450 , P < .001 ) , baseline body mass index ( beta = .204 , P = .045 ) , and total daily ingested proteins per body weight ( beta = .252 , P = .018 ) were predictive variables on the change in serum albumin ( R2 = 0.409 , F = 11.246 , P < .001 ) . CONCLUSIONS Oral nutritional supplements in normally nourished or only mildly undernourished geriatric patients with hip fracture su bmi tted to surgery may be of interest for patients with postoperative complications and long hospital stays BACKGROUND Patients who undergo surgery are at risk of malnutrition due to periods of starvation , the stress of surgery , and subsequent increase in metabolic rate . There are limited data on nutritional outcome of surgical patients . AIMS To investigate changes in nutritional status and the influence of oral supplements on nutritional status , morbidity , and quality of life in postoperative surgical patients . METHODS Entry was determined by the presence of malnutrition , as defined by a body mass index ( BMI ) ⩽20 kg/m2 , anthropometric measurements ⩽15th percentile on admission , or initiation of oral diet postoperatively and /or a weight loss of 5 % or more during the operative period . We studied 101 patients : 52 were r and omised to the treatment group ( TG ) and prescribed a 1.5 kcal/ml nutritional supplement ; 49 patients were r and omised to the control group ( CG ) and continued with routine nutritional management .  Nutritional status was assessed by weight , anthropometry , and grip strength , with measurements taken at two weekly intervals for 10 weeks . Complications , namely wound infection , chest infection , and antibiotic use were documented . Quality of life ( QOL ) was assessed using the UK SF-36 question naire . RESULTS Patients in the control group lost a maximum mean ( SD ) of 5.96 ( 4.21 ) kg in weight over a period of eight weeks while patients in group TG lost less weight overall ( maximum mean ( SD ) 3.40 ( 0.89 ) kg ( p<0.001 ) occurring at four weeks and progressively regained weight from week 4 ) . Anthropometry , grip strength , and QOL were similarly significantly different between groups ( p<0.001 ) . Fewer patients in the treatment group ( 7/52 ) required antibiotic prescriptions compared with the control group ( 15/49 ) . CONCLUSIONS Nutritional status declined for two months after discharge . Postoperative nutritional supplementation improved nutritional status , QOL , and morbidity in these patients OBJECTIVE To evaluate the effect of a short preoperative exercise intervention on the functional status , pain , and muscle strength of patients before and after total joint arthroplasty . METHODS A total of 108 men and women scheduled for total hip arthroplasty ( THA ) or total knee arthroplasty ( TKA ) were r and omized to a 6-week exercise or education ( control ) intervention immediately prior to surgery . We assessed outcomes through question naires and performance measures . Analyses examined differences between groups over the preoperative and immediate postoperative periods and at 8 and 26 weeks postsurgery . RESULTS Among THA patients , the exercise intervention was associated with improvements in preoperative Western Ontario and McMaster Universities Osteoarthritis Index function score ( improvement of 2.2 in exercisers versus decline of 3.9 in controls ; P = 0.02 ) and Short Form 36 physical function score ( decline of 0.4 in exercisers versus decline of 14.3 in controls ; P = 0.003 ) . No significant differences were seen in TKA patients . Exercise participation increased muscle strength preoperatively ( 18 % in THA patients and 20 % in TKA patients ) , whereas the control patients had essentially no change in strength ( P > 0.05 for exercise versus education in both THA and TKA groups ) . Exercise participation prior to total joint arthroplasty substantially reduced the risk of discharge to a rehabilitation facility in THA and TKA patients ( adjusted odds ratio 0.27 , 95 % confidence interval 0.074 - 0.998 ) . The intervention had no effects on outcomes 8 and 26 weeks postoperatively . CONCLUSION A 6-week presurgical exercise program can safely improve preoperative functional status and muscle strength levels in persons undergoing THA . Additionally , exercise participation prior to total joint arthroplasty dramatically reduces the odds of inpatient rehabilitation The potential nutritional and clinical benefits of sip-feed supplements were investigated by means of a controlled trial in elderly female patients admitted for orthopaedic surgery . A nutritional risk assessment procedure ( Nutritional Risk Question naire , NRQ ) was used to identify patients who might benefit from supplementation . Patients identified as high risk who did not receive supplements  showed significant losses in triceps skinfold thickness ( TSF ) and mid-upper arm muscle circumference ( MUAMC ) measurements during hospitalization . Such changes were not observed in high-risk supplemented patients , but significant losses of MUAMC were also recorded in a group of patients who failed to comply with the supplement . No differences in biochemical parameters , muscle function , or clinical outcome were observed between supplemented and unsupplemented and non-compliant patients . The problems of poor compliance to sip-feed supplements and failure to observe clinical benefit in supplemented patients are discussed Objectives : Assess whether postoperative nightly enteral nutrition support improves outcomes of elderly patients with an acute hip fracture Design : R and omized controlled trial Setting : A University and a Department of Veteran ’s Affairs Hospital Subjects : Adults > 64 years of age who underwent surgical repair of an acute hip fracture Interventions : Subjects r and omized to the  control ( Ctrl ) group received st and ard care while the treatment ( Tx ) group received st and ard care plus up to 1,375 Kcal [ 5,755 kJ/d ] of nasoenteral tube feedings each night . When tube feedings had to be discontinued , Tx subjects were asked to drink an equivalent amount of the nutritional supplement each night . Measures of Outcome : Rate of postoperative complications and 6-month postoperative survival Results : Fifty-seven patients were r and omized to the Tx ( n = 27 , mean age 75.9 ± 7.4 yrs ) or Ctrl groups ( age 81.7 ± 7.7 yrs ) . All subjects had reduced volitional nutrient intakes after surgery . During the first week subsequent to surgery , there was no difference between the treatment and control groups in the amount of nutrients that they volitionally consumed during the day . However , the treatment subjects had a greater total daily nutrient intake ( Median 5,866 ( IQR 5,024 to 7,335 ) kJ/d vs. 3,965 ( IQR 2,968 to 4,664 ) kJ/d , p < 0.001 ) . However , by the second postoperative week this difference was no longer statistically significant . Intolerance to the tube feedings developed commonly . There was no difference between the groups in the rate of postoperative life-threatening complications or mortality within six months subsequent to surgery . Conclusions : This study failed to confirm findings from a prior study of improved postoperative survival with nutrition support . However , it was conducted on multiple hospital wards which may have contributed to the higher rate of tube-related problems and less nutrient delivery signifying the need for further study
Intake of a carbohydrate-containing fluid is reported to improve insulin-like growth factor levels , reduce hunger , nausea , and length of stay , and attenuate the decrease in whole-body insulin sensitivity and endogenous glucose release .
Amino acid supplementation is reported to reduce muscle atrophy and accelerate return of functional mobility .
There is limited evidence for nutritional supplementation in THR and TKR pathways ; however , the low risk profile and potential benefits to adjunctive treatment methods , such as exercise programs , suggest nutritional supplements may have a role .
Optimizing nutritional status pre-operatively may help manage the surgical stress response , with a particular benefit for undernourished , frail , or elderly individuals
Nutritional supplements can influence outcomes for individuals undergoing major surgery , particularly in older persons whose functional reserve is limited .
Accelerating recovery from total hip replacement ( THR ) and total knee replacement ( TKR ) may offer significant benefits .
Therefore , we explored the role of nutritional supplements in improving recovery following THR and TKR .