Concomitant malnutrition and frailty are significant risk factors for poor outcome following two-stage revision for chronic periprosthetic joint infection.

BACKGROUND: Two-stage revision remains the gold standard for periprosthetic joint infection (PJI) treatment. Although previous studies have examined malnutrition and frailty independently, their cumulative effects are not clear. Therefore, this study aimed to assess the individual and combined influence of malnutrition and frailty on the two-stage revision surgery. METHODS: Patients with chronic PJI undergoing two-stage revision were retrospectively included. The definition of PJI is completely consistent with the evidence-based definition of PJI recorded by the MSIS in 2018. Preoperative serum albumin levels and 11-item modified frailty index scores were collected. Four cohorts were created: (1) Normal (N), (2) Frail (F), (3) Malnourished (M), and (4) Malnourished and frail (MF). Demographic data, comorbidities, and postoperative complications were collected and compared between the four cohorts. RESULTS: A total of 117 consecutive patients were enrolled, 48% of patients were healthy (27.4% F, 16.2% M, and 9.4% MF). MF group showed lower scores on the physical composite scale of the 12-item short-form health survey (SF12-PCS), mental composite summary (SF12-MCS), Harris hip score (HHS), and knee society score (KSS) (P < 0.05). The incidence of reinfection in the MF group was higher than that in all other groups (MF vs. N; odds ratio [OR] 3.7, 95% confidence interval [CI] 1.37 - 8.82, P = 0.032). The incidence of complications in the MF group was higher than that in all other groups (MF vs. N; OR 4.81, 95% CI 1.58-9.26, P = 0.018). Postoperative transfusion events (OR 2.92, 95% CI 1.27-3.09, P = 0.021), readmission at 60 days after the operation (OR 4.91, 95% CI 1.82-13.80, P = 0.012) was higher in the MF patients. In addition, the extended length of stay after the operation was highest in the MF patients, with an OR of 5.78 (95% CI 2.16-12.04, P = 0.003). CONCLUSION: The concurrent presence of concomitant malnutrition and frailty in patients with PJI is related to poor prognosis and may be a predictor of the efficacy of two-stage revision. Future research will be needed to describe the benefits of improving these risk factors for patients with PJI.

Does type 2 diabetes affect the efficacy of therapeutic exercises for degenerative lumbar spinal stenosis?

DESIGN: Propensity-matched retrospective study. OBJECTIVES: To determine whether type 2 diabetes mellitus (T2D) would affect prognosis in patients with degenerative lumbar spinal stenosis (DLSS) who underwent therapeutic exercises. METHODS: This study included consecutive patients with or without T2D who underwent therapeutic exercises for symptomatic DLSS from December 2018 to January 2020. Baseline demographics and clinical and radiological data were collected. The 2 groups of patients were further matched in a 1:1 fashion based on the propensity score, balancing the groups on pre-treatment factors including age, sex, leg and back pain, and low back disability. The primary outcomes included self-reported leg pain intensity (Numerical Rating Scale, NRS) and low back disability (Oswestry Disability Index, ODI) and the secondary outcomes included low back pain intensity and walking capacity (self-paced walking test, SPWT) were compared at baseline, 6 weeks, and 12 weeks. RESULTS: Forty-one pairs of patients were selected by propensity matching. After 6-week therapeutic exercises, patients with T2D achieved a lower improvement in leg pain at 6 weeks (NRS leg change, 1.21 ± 0.40 vs. 1.78 ± 0.52, P = 0.021) and 12 weeks (NRS leg change, 1.52 ± 0.92 vs. 2.18 ± 0.96, P = 0.007) above minimal clinically important difference (MCID), with a significant Group × Time interactions (F1,80 = 16.32, p < 0.001, ηp2 = 0.053). However, the two groups showed no difference in the improvement of ODI, although the sample had significant improvements at 6 weeks (ODI change 3.02 [95% CI, 2.08 to 2.77], P < 0.001) and 12 weeks ([ODI change 3.82 [95% CI, 4.03 to 4.90], P < 0.001), 46% of the patients achieved an MCID. CONCLUSION: Six-week therapeutic exercises have an inferior effect on DLSS patients with T2D. Findings from this study will provide an increased understanding of exercise treatment in patients with DLSS.