Multimodal Nutritional Management in Primary Total Knee Arthroplasty: A Randomized Controlled Trial.

BACKGROUND: This study aims at evaluating the effectiveness of a new multimodal nutritional management (MNM) on albumin (ALB) transfusion, the incidence of electrolyte disorders, blood loss, perioperative levels of ALB and electrolyte, length of hospital stay (LOH), and complications in patients following total knee arthroplasty without tourniquet.

METHODS: A total of 162 patients were randomized to receive either the MNM protocol (n = 81, experimental group) or traditional protocol (n = 81, control group). The primary outcomes were the rate and amount of ALB infusion, LOH, total blood loss, maximum hemoglobin drop, allogeneic transfusion rate, and the incidence of electrolyte disorders. The secondary outcomes were levels of ALB and electrolyte at different time points and the incidence of complications.

RESULTS: The rate and amount of ALB transfusion required in MNM group were significantly lower than those in control group (P = .006, P = .021, respectively). LOH was shorter in MNM group (P < .001). Total blood loss and maximum hemoglobin drop were similar. The incidence of kaliopenia and hypocalcemia was lower in MNM group on the first postoperative day (P = .019, P = .028, respectively). Patients in MNM group had higher levels of ALB, sodium, potassium, and calcium than those in control group on the first postoperative day.

CONCLUSION: The MNM protocol can effectively low down the amount of ALB transfusion, the number of patients requiring ALB transfusion, the incidence of electrolyte disorders, and LOH following primary total knee arthroplasty without tourniquet. Patients can obtain a smaller decline in ALB, sodium, potassium, and calcium.