Response to Letter to the Editor on "Hypoalbuminemia Predicts Failure of Two-Stage Exchange for Chronic Periprosthetic Joint Infection of the Hip and Knee".

We read with great interest the article by Green et al. “Hypoalbuminemia Predicts Failure of Two-Stage Exchange for Chronic Periprosthetic Joint Infection of the Hip and Knee,” published online on January 21, 2023 [ [1] Green C.C. Valenzuela M.M. Odum S.M. Rowe T.M. Springer B.D. Fehring T.K. et al. Hypoalbuminemia Predicts failure of two-stage exchange for chronic periprosthetic joint infection of the Hip and knee. J Arthroplasty. 2023; ([Epub ahead of print])https://doi.org/10.1016/j.arth.2023.01.012 Abstract Full Text Full Text PDF Scopus (0) Google Scholar ]. The purpose of their research was to examine the relationship between preresection nutrition and success after first-stage resection in planned 2-stage exchange for periprosthetic joint infection (PJI). We appreciate the great efforts of the authors because they conducted a well-conceived study that provided an interesting insight into nutritionally compromised patients, who had preoperative serum albumin (SAB) < 3.5 g/dL, and the risk for PJI in total joint arthroplasty. They concluded that low preoperative SAB (<3.5 g/dL) and Musculoskeletal Infection Society host type-C [ [1] Green C.C. Valenzuela M.M. Odum S.M. Rowe T.M. Springer B.D. Fehring T.K. et al. Hypoalbuminemia Predicts failure of two-stage exchange for chronic periprosthetic joint infection of the Hip and knee. J Arthroplasty. 2023; ([Epub ahead of print])https://doi.org/10.1016/j.arth.2023.01.012 Abstract Full Text Full Text PDF Scopus (0) Google Scholar ] are independent risk factors for failure following first-stage resection in planned 2-stage exchange for PJI. Efforts to nutritionally optimize PJI patients, when possible, may improve the outcome of 2-stage exchange. However, we would like to point out the following issues. Letter to the Editor on “Malnutrition Predicts Failure of Two-Stage Exchange for Chronic Periprosthetic Joint Infection of the Hip and Knee”The Journal of ArthroplastyVol. 38Issue 9PreviewWe appreciate the thoughtful commentary from Nunez et al. in response to our recent study titled “Hypoalbuminemia Predicts Failure of Two-Stage Exchange for Chronic Periprosthetic Joint Infection of the Hip and Knee.” We believe that the authors make some excellent points in their commentary regarding serum albumin (SAB) as a controversial marker of a patient’s nutritional status. They remind the readers that not only can hypoalbuminemia occur due to decreased SAB production (such as a malnourished state), but it can also occur via increased loss of SAB through the kidneys/gastrointestinal tract or by increased catabolism of albumin from an inflammatory state/underlying disease. Full-Text PDF