Postoperative decrease in serum albumin as predictor of early acute periprosthetic infection after total knee arthroplasty

Abstract Purpose Patients with hypoalbuminemia, often defined as serum albumin (SA) less than 3.5 g/dL, are at greater risk for complications after surgery. In particular, patients with hypoalbuminemia undergoing total knee arthroplasty (TKA) have an increased postoperative wound infection rate. Most studies, however, report only the preoperative SA. We aimed to analyze not just preoperative SA but also postoperative SA in patients who experienced acute periprosthetic infection in the first 4 weeks after surgery. Methods We retrospectively analyzed data from 490 consecutive TKAs (314 patients). Five patients developed early acute infection requiring surgical treatment. SA data were collected preoperatively (SA₀) and 1 week postoperatively (SA1W) to evaluate SA dynamics. Multiple patient and operative parameters that could influence SA were also analyzed. Results There were no statistical differences in any parameters that were expected to influence or might influence SA values in the perioperative period between the surgically treated (STG) and non-treated groups (non-STG). Furthermore, none of the patients in STG had SA₀ and SA1W below 3.5 g/dL. However, the amount and rate of SA reduction before and after surgery was significantly greater in STG than in non-STG. Conclusion SA dynamics revealed a greater reduction of both the amount and rate in STG before and after surgery than in non-STG. However, no correlation was found between early acute periprosthetic infection after TKA and each SA₀ and SA1W time point. We suggest that further evaluation of the SA value of 3.5 g/dL as a threshold for acute early acute infection is warranted.