Nutrition is a major part of health and nutritional habits can influence outcomes for people after surgery, especially in older adults. Two of the more popular orthopedic surgeries that older adults receive are hip replacements and knee replacements. These are major surgeries that create a stressful stimulus to our bodies which result in an increased inflammatory response and impairs our immune system due to metabolic changes. It is known that it is always good to optimize nutrition, especially prior to surgery. There are multiple supplements available as well that can stimulate our body’s metabolic response with the potential to speed up recovery.
In an article titled: What Is the Role of Nutritional Supplements in Support of Total Hip Replacement and Total Knee Replacement Surgeries? A Systematic Review; the authors analyzed nine research studies to determine the effectiveness of nutritional supplements specifically on the recovery after hip and knee replacement surgeries.
After review, there were three types of supplements studied including carbohydrate drink supplements prior to surgery, amino acid supplements prior to surgery, and Beta-Hydroxy Beta-Methylbutyrate, L-Arginine, and L-Glutamine (HMB/Arg/Gln) supplements, as well as other conclusions the authors have made from the available research.
- Carbohydrate Drinks Before Hip and Knee Replacement Surgery :
- evidence is limited
- may increase insulin-like growth factor 1 (IGF-1) levels which can be beneficial in reversing the metabolism changes that occur after the stress induced from surgery.
- may reduce hunger, nausea, and help regulate insulin growth sensitivity.
- One pilot study found that patients who took multiple nutritional interventions, one being a carbohydrate drink prior to surgery, had shorter hospital stays and decreased inflammation after hip replacement surgery.
- No conclusive evidence for benefits; HOWEVER low risk and high potential benefits which may be most beneficial for those who are frail or with multiple co-morbidities
- Amino Acids
- Some evidence to suggest decreased muscle atrophy (muscle loss) after surgery and better performance on functional tests at 2 weeks and 6 weeks post surgery
- Beta-Hydroxy Beta-Methylbutyrate, L-Arginine, and L-Glutamine (HMB/Arg/Gln)
- HMB is reported to promote muscle protein synthesis and suppress muscle protein breakdown
- Some evidence to suggest decreased muscle loss in quad muscle from 0-14 days post surgery
- Might lead to early improvements in physical function and fall prevention
- Additional Findings
- Consumption of protein is vital for stimulating muscle protein synthesis and can have greater impacts in frail or malnourished individuals.
- Pre-operative period is the most effective intervention time
- future work needs to be done in researching nutritional influence on muscle inflammation susceptibility using antioxidant ingredients or polyunsaturated fatty acids
- Study Limitations:
- Limited amount of data
- Small sample size in most research articles
- 2 pilot studies were used
Nutritional therapy is most beneficial to support individuals with a high risk of developing post-operative complications or are sarcopenic, frail, malnourished/undernourished and have a limited protein reserve. There are multiple factors that go into recovery from joint replacement surgery and nutritional supplements can be one of these important factors. It is supported that a combination of physical, nutritional, and psychological pre-operative preparation all have positive impacts on the recovery from surgery.
For more information on this topic and for more details regarding the research that was reviewed, please see the article referenced below. It is important for each person to understand the multiple factors that go into recovery from joint replacement surgery and to know that each person’s recovery is unique. At Physical Therapy First, we want to help make your recovery as smooth as possible. We understand that each person’s recovery is unique, that’s why we spend a full hour with each of our patients and provide each person with a rehabilitative routine that is specific for them. Check out our website and give us a call to schedule an appointment with us!
Burgess, L., Phillips, S. and Wainwright, T., 2018. What Is the Role of Nutritional Supplements in Support of Total Hip Replacement and Total Knee Replacement Surgeries? A Systematic Review. Nutrients, 10(7), p.820