The Nutrition Factor in PJI: Prevent Problems Before Surgery, Recover Stronger After

Beat joint infections before they start by harnessing the most overlooked—yet powerful—lever in joint infection care: nutritional optimization.

In joint replacement, implants, technique, and sterile protocols get the spotlight. Nutrition often doesn’t. Malnutrition isn’t a side issue; it compromises immune function, impairs wound repair, and is associated with higher failure rates after treatment of periprosthetic joint infection.

Xcelerated Recovery® highlights perioperative nutrition as a modifiable risk factor. The program pairs preoperative screening guidance with targeted supplementation and personalized nutrition planning to complement standard infection-control pathways and support outcomes across hip, knee, and shoulder surgery.

The Link Between Malnutrition and Joint Infections: What the Research Says

Recent studies from top journals including the Archives of Orthopaedic and Trauma Surgery, The Journal of Arthroplasty, and Nutrients have converged on one key insight: low albumin levels (a marker of poor nutritional and immune status) significantly increase the risk of treatment failure after joint infection surgery.

Some key findings:

• Hypoalbuminemia (<3.5 g/dL) was linked with a 5.6x increased risk of failure after a one-stage revision surgery for PJI.
• Patients with poor nutrition had nearly 9x higher failure risk after two-stage exchanges according to the CONUT score.
• Even patients undergoing standard revision THA for PJI with lower albumin levels were far more likely to experience reinfection and require further surgery.

⚠️ What’s Worse? Many Patients with Infections Are Already Malnourished

Infection causes inflammation. Inflammation causes protein breakdown. And the body's nutritional reserves, already low in many elderly or chronically ill patients, get rapidly depleted.

It’s a vicious cycle.

How XR® is Changing the Game with Nutrition-Based PJI Prevention and Recovery

nutritional status is not just a lab value, it’s a modifiable risk factor. That's why our approach includes:

✅ Preoperative Nutritional Screening Guides: 

✅ Targeted Supplementation:

✅ Personalized Nutrition Plans: Designed by clinical nutritionists personalized for  each patient

Why This Matters for Surgeons and Clinicians

If you’re an orthopedic provider, you know how devastating PJI can be, for patients and for practice outcomes. Nutrition is one of the few modifiable risk factors that can directly impact infection control, surgical outcomes, and healthcare costs.

With growing evidence showing that:

• Failure rates remain as high as 25% in 2-stage revisions,
• Malnutrition is prevalent in up to 50% of PJI patients,
• And preoperative optimization may prevent complications,

Nutritional Optimization is a central part of PJI management protocols.

For Patients: Your Role in Recovery Starts Before the Surgery

Whether you're getting a hip, knee or shoulder replacement, or you're being treated for an infection, you now have some control. Working with your care team to optimize your nutritional status can be one of the most important steps you take to improve your outcomes.

References:

1. Li Z, Maimaiti Z, Li ZY, Fu J, Hao LB, Xu C, Chen JY. Moderate-to-Severe Malnutrition Identified by the Controlling Nutritional Status (CONUT) Score Is Significantly Associated with Treatment Failure of Periprosthetic Joint Infection. Nutrients. 2022 Oct 21;14(20):4433. doi: 10.3390/nu14204433. PMID: 36297116; PMCID: PMC9607573.
2. Traverso, G., Núñez, J.H., Gehrke, T. et al. Hypoalbuminemia increases the risk of failure following one-stage septic revision for periprosthetic joint infection. Arch Orthop Trauma Surg 143, 5641–5648 (2023). https://doi.org/10.1007/s00402-023-04885-z
3. The Effect of Nutritional Status in the Treatment of Periprosthetic Joint Infections in Total Hip Arthroplasty Scarcella, Nicholas R. et al. The Journal of Arthroplasty, Volume 39, Issue 9, S225 - S228
4. Green CC, Valenzuela MM, Odum SM, Rowe TM, Springer BD, Fehring TK, Otero JE. Hypoalbuminemia Predicts Failure of Two-Stage Exchange for Chronic Periprosthetic Joint Infection of the Hip and Knee. J Arthroplasty. 2023 Jul;38(7):1363-1368. doi: 10.1016/j.arth.2023.01.012. Epub 2023 Jan 21. PMID: 36693515.