{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T16:44:22Z","timestamp":1792082662568,"version":"4.4.0"},"reference-count":77,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T00:00:00Z","timestamp":1792022400000},"content-version":"vor","delay-in-days":14,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["esskajournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J. exp. orthop."],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>To report the effect of nutritional disorder on outcomes following hip and knee arthroplasty using European Society of Clinical Nutrition and Metabolism (ESPEN) diagnostic criteria.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A systematic review of level 1\u20134 evidence was conducted as per the PRISMA statement and Cochrane Handbook for Systematic Review (PROSPERO ID: CRD42023360517). In March 2024, AMED, CENTRAL, EMABASE, MEDLINE, Scopus and Web of Science were searched. Articles were included if they defined and reported the effect of nutritional disorder on outcome(s) of interest following hip and\/or knee arthroplasty. Exclusion criteria were pathological fracture and &lt;50 cases. The ROBINS\u2010I was used to assess study bias. Data were presented with effect sizes if reported.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Fifty\u2010eight studies were included (2,076,289 patients). Malnutrition, as per ESPEN criteria, increased mortality, post\u2010op pain and length of hospital stay. Sarcopenia, diagnosed via computed tomography, increased surgical site infection rate following primary arthroplasty and mortality following hip fracture arthroplasty. Frailty worsened clinical outcomes following primary, revision and hip fracture arthroplasty. One included study reported healthcare cost; these were higher among frail patients undergoing primary total knee arthroplasty: $19,841 versus $6104,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.001.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Nutritional disorder was associated with adverse clinical outcomes following primary, revision and hip fracture arthroplasty. Moderate\u2010to\u2010severe bias, heterogenous definitions of nutritional disorder and lack of standardised outcome reporting limited analyses, particularly analyses of healthcare costs which likely increase with nutritional disorder. Prospective study is required to examine potential for cost\u2010saving and improved patient outcome following treatment of nutritional disorder in hip and knee arthroplasty populations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>Level IV.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jeo2.70657","type":"journal-article","created":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T15:44:32Z","timestamp":1792079072000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Nutritional disorders have adverse effect on clinical outcomes and may increase healthcare costs following hip and knee arthroplasty\u2014A systematic review"],"prefix":"10.1002","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1977-2193","authenticated-orcid":false,"given":"Christopher David John","family":"Little","sequence":"first","affiliation":[{"name":"Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences (NDORMS) Oxford UK"},{"name":"Oxford University Hospitals NHS Foundation Trust Oxford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5471-9120","authenticated-orcid":false,"given":"Hariharan Subbiah","family":"Ponniah","sequence":"additional","affiliation":[{"name":"Imperial College Healthcare NHS Trust London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4699-228X","authenticated-orcid":false,"given":"Shvaita","family":"Ralhan","sequence":"additional","affiliation":[{"name":"Oxford University Hospitals NHS Foundation Trust Oxford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4486-1868","authenticated-orcid":false,"given":"Louise","family":"Strickland","sequence":"additional","affiliation":[{"name":"Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences (NDORMS) Oxford UK"},{"name":"Oxford University Hospitals NHS Foundation Trust Oxford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4616-7482","authenticated-orcid":false,"given":"Antony","family":"Palmer","sequence":"additional","affiliation":[{"name":"Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences (NDORMS) Oxford UK"},{"name":"Oxford University Hospitals NHS Foundation Trust Oxford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6852-3834","authenticated-orcid":false,"given":"Thomas William","family":"Hamilton","sequence":"additional","affiliation":[{"name":"Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences (NDORMS) Oxford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,15]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1016\/j.arth.2018.09.037","article-title":"Sarcopenia as a risk factor for prosthetic infection after total hip or knee arthroplasty","volume":"34","author":"Babu JM","year":"2019","journal-title":"J Arthroplasty"},{"key":"e_1_2_13_3_1","doi-asserted-by":"crossref","first-page":"3388","DOI":"10.1016\/j.injury.2021.07.027","article-title":"Radiological parameter associated with the survival of old patients with hip fracture","volume":"52","author":"Bayram S","year":"2021","journal-title":"Injury"},{"key":"e_1_2_13_4_1","doi-asserted-by":"crossref","first-page":"2971","DOI":"10.1016\/j.arth.2018.04.027","article-title":"Malnutrition and the development of periprosthetic joint infection in patients undergoing primary elective total joint arthroplasty","volume":"33","author":"Blevins K","year":"2018","journal-title":"J Arthroplasty"},{"key":"e_1_2_13_5_1","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1016\/j.arth.2015.08.028","article-title":"Hypoalbuminemia independently predicts surgical site infection, pneumonia, length of stay, and readmission after total joint arthroplasty","volume":"31","author":"Bohl DD","year":"2016","journal-title":"J Arthroplasty"},{"key":"e_1_2_13_6_1","doi-asserted-by":"crossref","first-page":"963","DOI":"10.1016\/j.arth.2015.11.025","article-title":"Is hypoalbuminemia associated with septic failure and acute infection after revision total joint arthroplasty? 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