Background:Total knee arthroplasty (TKA) outcomes are mainly assessed using radiographic and clinical survival analysis. Recently, several studies have been published on patient-reported outcome measures. However, data on functional performance differences between primary and revision TKA (rTKA) are limited. The study aims to compare the functional performance of primary and revision TKA. Patients/Methods:Twenty-nine patients with primary TKA and rTKA were included in this study. Patients completed the performance-based tests of the 3-meter Backwards Walk Test (3MBWT), the modified Four Square Step Test (mFSST), and the Figure-of-Eight Walk Test (F8WT). Their pain levels and the Hospital for Special Surgery (HSS) knee scores were determined. Results:Age, gender, body mass index, time after surgery, pain level, and HSS scores were similar across groups. Surgery in the rTKA group was predominantly indicated for sepsis (26/29). The 3MBWT, mFSST, and F8WT scores of the rTKA patients were lower than those of patients who had primary TKA (p < 0.05). Discussion:The functional performances related to fall risk, dynamic balance, stepping, and various walking skills after predominantly septic first-time rTKA were poorer than after primary TKA, with medium effect sizes. These results offer patients realistic expectations after TKA and rTKA, predominantly septic first-time rTKA. Clinicians and patients should make additional efforts to improve the durability of the primary operation and reduce the need for future revision surgery. Additionally, rTKA patients may require more intensive, comprehensive rehabilitation programs.
Background Traumatic spondyloptosis has been described as the most severe form of vertebral dislocation. It is characterised by the complete subluxation of a vertebral body by more than 100% relative to the adjacent vertebra. In general, traumatic spondyloptosis can occur in all sections of the spine. It is an extremely unstable injury that requires immediate surgical stabilisation. The aim of this study was to conduct a systematic analysis and evaluation of diagnostic procedures, therapeutic concepts, and surgical strategies for this serious injury.Methods Due to the limited number of studies, the systematic literature analysis mainly includes case reports. The updated 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Guideline were used for methodological structuring and evaluation.Results A total of 106 publications were identified, of which 43 met the defined inclusion criteria. The focus was on case reports on the surgical treatment of traumatic spondyloptosis in humans. A total of 12 articles related to the cervical section of the spine and formed the basis for further analysis.Conclusion Surgical treatment of traumatic cervical spondyloptosis is essential to ensure stable reconstruction and neurological care. Early diagnosis, preoperative neurological status, and an individualised surgical approach are crucial for the functional outcome.
Diagnosing periprosthetic joint infection (PJI) can be challenging, particularly in cases involving biofilm-forming organisms or low-virulence pathogens. Currently, no single test provides perfect sensitivity and specificity. However, distinguishing septic from aseptic complications is crucial for selecting an appropriate treatment strategy, reducing morbidity and mortality, and preserving joint function. The introduction of standardized infection definitions in 2011 has supported diagnostic accuracy and improved comparability between studies. Based on these PJI definitions, diagnosis relies on a combination of test methods, including clinical signs, serum parameters, joint aspiration, microbiological cultures (synovial fluid, tissue, sonication), histological analysis, and imaging. Preoperatively, the most accurate tests are the synovial leukocyte count and the percentage of polymorphonuclear neutrophils (%PMN). While synovial fluid culture may enable preoperative pathogen detection, its sensitivity is limited. Intraoperatively, 4-6 tissue samples should be collected for culture and histological evaluation. Tissue cultures are highly specific but may yield false-negative results in low-grade infections or in patients pre-treated with antibiotics. Histology (permanent sections), when performed with an optimal sampling technique, is one of the most reliable intra- and postoperative diagnostic modalities. Frozen sections allow for rapid intraoperative diagnosis. Sonication of removed implants is used to complement microbiological analysis. Additionally, molecular techniques such as next-generation sequencing (NGS) show promising results and may serve as useful adjuncts to conventional culture methods.
Various osteotomy measurement techniques to assess the posterior condylar angle (PCA) are utilized in total knee arthroplasty (TKA). However, the most accurate method remains unclear. This study made use of preoperative two-dimensional (2D) computed tomography (CT) images to measure the PCA and integrated three-dimensional (3D) printing technology for in vitro verification and to improve preoperative planning of osteotomy measurement techniques in TKA.A retrospective study was conducted involving a limited cohort of 10 patients diagnosed with knee osteoarthritis. These patients underwent three-dimensional CT reconstruction of the knee joint using a medical 3D model. This study employed three distinct methodologies to measure the PCA. The first method involved single-plane 2D CT measurement, which provides a clear assessment of the posterior femoral condyle axis line (PCAL) and the surgical epicondylar axis (sTEA) of the femur. The second method utilized multiplane 2D CT with continuous plane sliding positioning to identify both the PCAL and sTEA when measuring PCA. The third method incorporated a 3D printing model whereby a solid model of the patient's distal femur was fabricated using 3D printing technology. In this approach, the PCAL and sTEA were marked using in vitro Kirschner wires, followed by CT scans of the marked femur. The PCA was subsequently measured based on the positioning of the Kirschner wires, with the PCA obtained from the 3D printed model considered the reference standard. The accuracy and consistency of PCA measurements obtained from different CT planes were evaluated using paired sample t-tests and intraclass correlation coefficients (ICC).In the single-plane 2D CT measurement group, the PCA value was 1.33 ± 0.50° (0.83-2.1°, 95% CI: 0.97-1.69°) with a measurement error of -0.84 ± 1.12° (-3.24-0.87°, 95% CI: -1.64--0.04°) and an outlier rate of 10%. In the multiplane 2D CT sliding measurement group, the PCA value was 1.61 ± 0.38° (1.13-2.32°, 95% CI: 1.34-1.88°) with a measurement error of -0.56 ± 1.09° (-2-1.6°, 95% CI: -1.34-0.22°) and no abnormal values were detected. The PCA measurement value for the 3D printed model group was 2.17 ± 1.16° (0.23-4.01°, 95% CI: 1.34-3.00°). The PCA measurement values in the single-plane 2D CT group were significantly lower than those in both the multiplane 2D CT sliding measurement group and the 3D printed model group, with no significant difference observed between the latter two groups. Moreover, the measurement error and outlier rates in the multiplane 2D CT sliding measurement group were significantly lower than those in the single-plane 2D CT group. The PCA measurements in the single-plane 2D CT group exhibited moderate repeatability (ICC: 0.507-0.641) while those in the multiplane 2D CT sliding group demonstrated high consistency (ICC: 0.840-0.940).The utilization of multiplane 2D CT sliding measurements to assess the PCA during preoperative measurement and osteotomy planning for TKA demonstrates high accuracy and repeatability. We recommend employing this method prior to surgery to determine the rotational positioning of the femoral prosthesis during osteotomy and improve the precision of the rotational alignment of the femoral prosthesis.
Background Early recognition of patients at risk for surgical site infection (SSI) after lumbar interbody fusion (LIF) may allow timely intervention. This study assessed the predictive value of inflammatory, nutritional, and renal markers for SSI-related revision surgeries. Methods In this retrospective single-center study, 187 patients undergoing LIF were analyzed. C-reactive protein (CRP), leukocyte count, glomerular filtration rate (GFR), creatinine, and albumin were measured perioperatively. Patients requiring revision for SSI were compared with those without the need for revision surgery. Receiver operating characteristic (ROC) analysis was used to determine cut-offs, area under the curve (AUC), sensitivity, and specificity. Odds ratios (OR) with 95% confidence intervals (CI) were calculated. Results SSI-related revision was required in 14.4% of patients. CRP peaked on postoperative day (POD) 3-4 in both groups but declined significantly only in non-revision cases (p < 0.0001). On POD 3-4, CRP > 111 mg/l predicted SSI (AUC = 0.72, 95%CI: 0.61-0.82, p = 0.012; OR = 3.48, 95%CI: 1.30-9.30, p = 0.013). Preoperative albumin was significantly lower in the SSI group (p = 0.004) with a predictive value on POD 1-2, when albumin < 33 g/l had the best discrimination (AUC = 0.74, 95%CI: 0.62-0.84, p = 0.04; OR = 4.15, 95% CI: 1.35-12.74, p = 0.038). The decline in GFR from baseline to POD 7-8 was significantly greater in group 1 (p = 0.021). Conclusion Persistent CRP elevation beyond POD 3-4, early postoperative hypoalbuminemia, and greater GFR decline identify patients at increased risk for SSI-related revision after LIF. Combined perioperative monitoring of inflammatory, nutritional, and renal markers may enable early risk stratification and targeted intervention.
Abstract:Fractures of the diaphysis of the lower leg account for approximately 6% of all fractures in children and adolescents. A distinction must be made between isolated tibial shaft fractures, which are primarily managed conservatively, and combined lower leg shaft fractures (involving both the tibia and fibula). The latter are significantly less stable and therefore more frequently treated with osteosynthesis. If the fracture is non-displaced or tolerably displaced, immobilization in a long leg cast for about 4 weeks is sufficient. This requires that no secondary displacement occurs within the cast, which is why at least one follow-up X-ray after about 7-10 days is mandatory. In cases of instability, non-tolerable displacement, open fractures, or (impending) compartment syndrome, surgical treatment is indicated. The elastic stable intramedullary nailing (ESIN) technique is the standard procedure in these cases due to its low risk profile, broad applicability, minimally invasive approach, and good functional outcomes. After ESIN osteosynthesis, immobilization in a cast is not necessary. Other osteosynthesis methods, such as external fixation or plate osteosynthesis, are reserved for special cases like grade III open fractures, refractures, or comminuted fractures. The prognosis for tibial and lower leg shaft fractures in children is very good when conservative or surgical therapy is carried out correctly. Complications such as compartment syndrome, pseudarthrosis, or clinically relevant leg length discrepancies are rare. It is important to be familiar with the age-dependent tolerance limits for remodeling of the lower leg shaft, so that in the event of failure of conservative therapy, the indication for surgical treatment can be made in a timely manner and permanent malalignment of the lower leg with resulting abnormal loading of the knee and ankle joints can be avoided. An important and common special form is the so-called toddler's fracture, which occurs exclusively in early childhood. This involves a subtle, non-displaced spiral fracture or fissure of the tibial shaft, typically caused by a minor fall, often with a rotational component. These fractures can be easily missed on initial X-ray diagnostics. Immobilization for pain relief is sufficient, and follow-up radiological examinations are generally not necessary.
Background:Waste management is an essential component of ecological sustainability. The healthcare sector generates approximately 5 million tons of waste annually, contributing about 5% of national CO2 emissions. A major proportion originates from hospitals, up to 30% from operating theatres. The disposal of this waste produces high emissions. However, a significant part of this waste consists of valuable materials that could be recycled. Methods:In this prospective study, volume and weight of waste generated in operating theatres for trauma surgery were measured and analysed statistically. After analysis of standard disposal practice, the surgical staff received training, followed by waste segregation into potentially recyclable material and hospital-specific waste. Results:Prior to waste segregation, the mean volume and weight of waste per operation were 219.6 l (± 88.4 l) and 6.65 kg (± 2.92 kg), respectively. The implementation of waste separation resulted in a reduction by 39.48% in volume (z=-4.11; p < 0.01) and 15.44% in weight (z=-2.59; p = 0.01). Conclusion:Effective waste segregation in the operating theatre enables the reintegration of recyclable materials into circular economies, leads to significant reduction of waste and decreases the carbon footprint. Comprehensive staff education and structured implementation of waste separation in operating theatres are therefore essential.
Background:Approaches to the diagnosis and treatment of pyogenic spondylodiscitis vary significantly across German-speaking countries. To assess current clinical practice and compare it with prior data, a survey was conducted following the publication of the 2020 S2k guideline on the diagnosis and treatment of spondylodiscitis. Methods:A standardized and anonymized 32-item online questionnaire was distributed to members of the German Spine Society (DWG) between April and September 2021. The survey evaluated diagnostic workflows, therapeutic strategies, and guideline adherence in Germany, Austria, and Switzerland (DACH region). Findings were compared with data from a similar survey conducted in 2014. Results:A total of 220 respondents completed the survey; 36% worked in certified spine centres. Decisions regarding diagnosis and treatment were most frequently made during internal team meetings (60.3%) or by senior physicians (59.3%). Interdisciplinary case conferences were held in 30.8% of hospitals. Two-thirds of respondents reported the use of standardized operating procedures (SOPs), and 75.2% had integrated the current guideline into clinical routines.Diagnostic procedures were largely standardized: 98% performed focused history taking and source identification. Common investigations included echocardiography, urinalysis, chest X-ray, and whole-spine MRI-all used by over 80% of respondents. In more than 85% of cases, diagnosis was based on imaging, CRP levels, and clinical symptoms, followed by microbiological confirmation.In conservative treatment settings, targeted antibiotic therapy was initiated after pathogen identification in 74% of cases; in surgically managed cases, this occurred in 36%. Sepsis and fever were the most common reasons for empirical (non-targeted) therapy. The most frequently used empirical agents were clindamycin (41.6%) and ampicillin/sulbactam (28.3%). Results:Initial treatment was administered intravenously for at least two weeks in 85.2% of cases, followed by oral therapy for a total duration of 6-12 weeks in 83%. Therapy duration ≤ 6 weeks was reported by 10.1%. Biofilm-active antibiotics were used in 49.3% of cases-especially when foreign material was present (59.8%) or newly implanted (50.2%).Emergency surgery was most often triggered by neurological deficits and epidural abscesses. Titanium was the most frequently used material for defect reconstruction (81%). Locally applied antibiotics included gentamicin (66.2%) and vancomycin (57.9%). Orthotic bracing was prescribed by 67.7% of respondents during conservative treatment.Notable differences between certified and non-certified institutions were found in the selection of empirical antibiotics and the use of locally applied agents. Conclusion:Since the last survey in 2014, clinical management of spondylodiscitis in the DACH region has shown increased standardization, particularly in diagnostic procedures and guideline implementation. However, variability remains in empirical antibiotic selection and the use of local antimicrobial therapy, underlining the need for further harmonization of treatment strategies.
Background Developmental dysplasia of the hip (DDH) is among the most common congenital musculoskeletal disorders and may lead to early hip osteoarthritis if left untreated. Modified Pemberton acetabuloplasty is an established, growth-preserving osteotomy technique for surgical correction in childhood. However, robust clinical long-term outcomes with follow-up periods exceeding two decades have not yet been published. The aim of this study was to retrospectively evaluate functional and patient-reported outcomes after an average follow-up of 25.6 years. Methods In this monocentric retrospective cohort study, 63 patients (92 hips) were included from an original cohort of 331 patients with 507 operated hips who had undergone modified Pemberton acetabuloplasty between 1990 and 1995. In 2018, clinical follow-up was performed in 54 patients; all participants completed standardised questionnaires, including the Harris Hip Score (HHS), WOMAC, and EQ-5D. Data analysis was descriptive. Results The mean follow-up period was 25.6 years. The average HHS was 95.8 points, the mean WOMAC index 7.2 points, and the EQ-5D-VAS 89.3/100. A total of 81% of patients were free of symptoms, and 83.3% achieved excellent functional results. Overall, 96.8% rated the surgical outcome as good or very good, and 92% would choose to undergo the procedure again. No patient required total hip arthroplasty. No major postoperative complications occurred. Conclusion Modified Pemberton acetabuloplasty demonstrates stable functional outcomes, low symptom levels, and high health-related quality of life more than 25 years after surgery. The very high patient satisfaction and the absence of secondary procedures underscore the long-term clinical effectiveness of this growth-preserving technique.
With the commencement of EU Regulation 2017/745 (Medical Device Regulation, MDR), a justification and labelling obligation for medical devices was introduced for substances (chemicals, elements) that are proven or suspected to be carcinogenic, mutagenic or toxic to reproduction (CMR substances). This also applies to substances having endocrine disrupting properties. This obligation has led to great concern in the industry and among medical professionals, particularly with regard to possible uncertainty on the part of patients and users. The aim of this article is to clarify the most important context in order to counteract these concerns.For patients, the CMR labelling requirement will not result in any changes in the quality of care. On the other hand, the medical profession has the additional task of conveying a sense of security to their patients despite an uncontrollable public debate. The use of a ceramic head instead of a metal head in hip joint replacement can be cited as an example here.CMR-labelled implants pose only a very low risk to the patient due to the material, which only occurs in very rare cases if the restoration fails. In the future, however, manufacturers must aim to qualify more CMR-free materials. However, this is a cost- and time-intensive endeavour under the regulations of the MDR with high requirements, particularly with regard to clinical efficacy. The well-established tried-and-tested implant materials have proven to be clinically successful even in difficult revision situations. Switching completely to a different material without the corresponding clinical experience could potentially lead to losses in component safety.The implementation of the CMR labelling requirement should be closely monitored by both the medical profession and manufacturers in order to counteract any uncertainty among patients at an early stage.
Background:Femoral shaft fractures in childhood and adolescence are rare but serious injuries. The aim of the present study is to investigate the incidence and care structure of femoral shaft fractures in childhood and adolescence based on the complete hospital case data in Germany. Materials and Methods:For this retrospective, controlled registry study, the hospital case data of the Institute for the Hospital Remuneration System (InEK) for all patients treated as inpatients in Germany from 01/2019 to 09/2024 were evaluated. In addition to demographic data, the principal diagnoses, all secondary diagnoses, all billed procedures and the structural data of the treating hospital were analysed. Inclusion criteria were a femoral shaft fracture as the principal diagnosis and age between 3 and 17 years. Patients were assigned to the age groups 3-9 years (I), 10-15 years (II) and 16-17 years (III). Results:The study analyses the inpatient treatment data of 7234 patients with the principal diagnosis femoral shaft fracture (S72.3). The incidence of femoral shaft fractures in childhood and adolescence in Germany is 11.2/100000. The group of 3-9-year-olds was treated predominantly with elastic stable intramedullary nailing (ESIN). In patients older than 15 years, ESIN was no longer used; these patients were predominantly treated with rigid intramedullary nail osteosynthesis. Length of stay increased with age from 3.8 days in group I to 5.8 days in group II and 8.3 days in group III. The majority of patients were treated in hospitals with more than 600 beds. Only 4% of the fractures were open fractures. In 2.7% of cases there was a mechanical complication of the osteosynthesis. 27% of the surgical procedures were implant removals. Discussion and Conclusion:The incidence of femoral shaft fractures in childhood and adolescence in Germany is 11.2/100000 and shows an age- and sex-dependent pattern. ESIN intramedullary nailing is the most common operative method up to the age of 15 years and is no longer used beyond 16 years.
Purpose Postoperative epidural fibrosis (PEF) is a significant complication following lumbar disc herniation surgery. It is characterised by the formation of non-physiological scar tissue that may lead to recurrent radicular pain and contribute to failed back surgery syndrome (FBSS). Despite its clinical relevance, the exact incidence and effective management strategies for LPEF have not been adequately quantified in the existing literature. Methods This study analyses a cohort of 2673 patients who underwent surgical intervention for herniated lumbar discs between September 2010 and August 2023, focusing on 1974 patients monitored for up to one year post surgery. Results The study reports on the incidence of postoperative fibrosis, with 97 patients diagnosed with this condition. Over 61% of these patients experienced inadequate relief following various treatment modalities, including epidural steroid injections and anti-neuropathic medications. Conclusion The findings indicate that while corticosteroid injections provided relief for a minority (23.61%) of patients, a substantial proportion continued to experience pain, necessitating referral to pain management centres. This research contributes to the understanding of LPEF's impact on patient outcomes and underscores the need for further investigation into effective preventive and therapeutic strategies during postoperative care.
Background:Knee osteoarthritis (OA) is a widespread joint disease with no disease-modifying treatments. Chondrocyte damage is a key process in knee OA and ferroptosis is lipid peroxidation-induced iron-dependent cell death that exacerbates the process of knee OA and aggravates an imbalance in the synthesis as well as degradation of matrix metallopeptidase 13 (MMP13) and type II collagen. The clinical diagnosis of knee OA mainly depends on imaging. Whether ferroptosis-related genes could be used as new biomarkers for the diagnosis of OA remains to be explored. Methods:A dataset was used to build a diagnostic model used to diagnose and differentiate patients with end-stage knee OA. Normalization and quality control of the three profiles was carried out using R 4.1.0. Results:Analysis of a dataset (GSE114007) of differentially expressed genes (DEGs) found that the expression of 15 ferroptosis-related genes, including activating transcription factor 3 (ATF3), cyclin-dependent kinase inhibitor 1A (CDKN1A), and cytochrome b-245 beta chain (CYBB), showed significant changes in osteoarthritic chondrocytes relative to normal subjects. Based on 15 ferroptosis-related genes, we developed and compared diagnostic models using different supervised learning algorithms. Conclusions:The diagnostic model based on the support vector machine gave a convincing diagnostic performance for both verifications (Area Under Curve [AUC] = 0.9601) and testing (AUC = 0.8725). The results collectively indicate that ferroptosis-related genes may play an indispensable role in knee OA and could be specific diagnostic biomarkers for knee OA.
Purpose:Diabetic foot syndrome (DFS) occurs in 15-25% of diabetic patients. Identification of risk factors for malnutrition and prevention is valuable for patients with DFS. The aim of this study was to investigate the association between blood parameters and nutritional indices obtained from simple blood parameters and diabetic foot amputations. Methods:A single-center cross-sectional observational study was conducted between March 2024 and March 2025. According to whether they underwent amputation, including amputations of minor and major lower extremities, patients were divided into two groups: amputated (Group A) and non-amputated (Group NA). Patients older than 18 years with a DFD diagnosis were included. Data was analyzed statistically. Results:A total of 237 DFS patients were included in the study, with 92 patients in Group A and 145 patients in Group NA. CRP/albumin ratio (p < 0.001), albumin/globulin ratio (p = 0.003), PNI (p < 0.001), and CONUT score (p < 0.001) results revealed statistically significant differences between groups. CONUT score demonstrated significant associations in univariate and multivariate analyses. Patients with a CONUT score ≥ 5 had a 2.28 times higher risk of amputation compared to patients with a CONUT score < 5. Conclusion:Our results showed significant correlations between CONUT score and amputation as well as a significant association between both CONUT scores and CONUT severity, and diabetic foot amputations. This study also demonstrates that the CONUT score is a significant predictor of amputation risk in patients with diabetic foot disease, with those having a CONUT score ≥ 5 showing a 2.28-fold increased risk of amputation.
Due to the distinctive heterogeneity of the functional and biomechanical effects of posttraumatic fracture sequelae subsequent to proximal humerus fractures, there are no validated therapy guidelines yet and the majority of existing studies have concentrated on endoprosthetic treatment options. This retrospective clinical study which directly compares the functional outcome of patients after corrective osteotomy and osteosynthesis with that of patients treated with reverse total shoulder arthroplasty was therefore needed to demonstrate that the functional outcome after joint-preserving treatment provides better results, as shown by the Constant score and range of motion, and identifies the specific criteria relevant for treatment decision-making with a focus on joint preservation.Clinical follow-up examinations were performed after the respective revision surgeries and information was collected about patients' postoperative status (e. g. rating scale for pain, range of motion). Postoperative function was evaluated and analyzed using standardized shoulder scores (Constant score, Simple Shoulder Test, Subjective Shoulder Value).A total of 29 patients were enrolled, with 11 receiving joint-preserving treatment (group A) and 18 treated with arthroplasty (group B). Follow-up examinations were carried out at 38.3 ± 30.2 months after revision surgery. In addition to the higher satisfaction level in group A, lower levels of pain, and a higher range of motion, the Constant score (71.4 ± 11.6 points vs. 54.1 ± 15.3 points, p = 0.008), the Simple Shoulder Test (80.3 ± 16.8 % vs. 54.6 ± 28.3 %, p = 0.011) and the Subjective Shoulder Value (75.5 ± 15.4 % vs. 58.1 ± 20.9 %, p = 0.021) each demonstrated significantly better results for group A.These findings showed better clinical outcomes after joint-preserving therapy, which suggests that it is the better treatment option. Patients < 60 years of age with good bone quality, intact rotator cuff muscles, and a respective patient individually functional entitlement benefit from a joint-preserving approach, which should consequently be the preferred treatment option. For patients > 60 years of age, however, secondary endoprosthetic treatment of fracture sequelae is still indicated, due to progressively degenerative lesions of the rotator cuff muscles and/or of the glenohumeral joint itself in this age group.
The healing of a bone fracture depends on the complex interaction between biology and mechanics. If this interaction is disrupted, a pseudarthrosis may develop. This results in significant impairments in quality of life for the affected individuals. For the selection of the appropriate therapy, which often requires surgical intervention, the frequently multifactorial underlying etiology must be accurately identified. The five pillars of pseudarthrosis treatment are: stable fixation, mechanical alignment, biological stimulation, optimization of modifiable factors, early functional rehabilitation.
Delirium is a common complication in elderly patients after total hip arthroplasty (THA). Malnutrition is common in the elderly and is closely associated with developing postoperative delirium (POD). Therefore, preoperative assessment of the patient’s nutritional status is necessary. The geriatric nutritional risk index (GNRI) is a reliable indicator of nutritional status in the elderly population, but the relationship with postoperative delirium is not clear. The aim of this study was to determine the effect of preoperative GNRI on postoperative delirium. We reviewed 688 elderly patients who underwent primary elective THA at our medical center between 2013 and 2023. Delirium was diagnosed by reviewing postoperative medical records during hospitalization, using diagnostic criteria from the Diagnostic and Statistical Manual IV and the Confusion Assessment Method. Propensity matching was used to match patients in the delirium and non-delirium groups. Multiple logistic regression analysis was used to determine the association between GNRI and postoperative delirium. The validity of the GNRI for predicting POD was assessed by the area under the receiver operating characteristic curve (AUC) and the optimal prediction threshold was calculated. When matched, the GNRI was significantly higher for the delirium group than the non-delirium group (89.0 ± 8.0 vs. 99.8 ± 8.1, p < 0.001). In multivariate logistic regression analysis, GNRI was an independent risk factor for POD, and the incidence of POD increased with lower GNRI (OR 0.846, 95% CI 0.792–0.904, p < 0.001). The results of the ROC analysis showed an AUC of 0.827 and a prediction cut-off of 95.7 for the GNRI (sensitivity: 85.7%, specificity: 68.6%). In elderly patients, a lower GNRI was significantly associated with the occurrence of POD after THA. Assessing GNRI prior to THA in elderly patients may be effective in predicting the risk of POD.
