Overview
Research Article Title: Preoperative Nutrition in Orthopedic Surgery
Authors: Aepala et al.
Published in: The Journal of Bone and Joint Surgery
Date of Publication: December 5, 2025
Link to Article →
Summary
Orthopedic procedures are among the most common surgical interventions, yet formal guidance on perioperative nutrition remains limited. Many patients, especially those with sarcopenia, osteoporosis, obesity, or frailty, enter surgery already malnourished, which correlates with worse outcomes.
Ultimately, the involvement of a Registered Dietitian as part of the clinical care team can directly impact recovery through nutritional screening and improved personalized planning while helping identify and treat malnutrition prior to surgery.
Key Findings
- Carbohydrate Loading: Oral carbohydrate solutions consumed up to 2 hours before surgery can improve insulin sensitivity, reduce protein catabolism, and may reduce pain and anxiety.
- Protein: Increasing protein intake to 1.2–1.5 g/kg/day, with up to 2.0–3.0 g/kg/day during rehabilitation, while consuming 20–40 grams per meal or snack throughout the day, should begin at least 1 month before surgery.
- Essential Amino Acids: Free-form essential amino acids starting 1 week before surgery through 6 weeks after surgery may support muscle recovery due to rapid absorption into the bloodstream.
- Iron: Iron supplementation is critical to address preoperative anemia and reduce transfusion needs.
- Vitamin D: Vitamin D supplementation supports bone health, immune function, and may reduce complications. Screening current vitamin D levels is important to ensure appropriate supplementation.
- Omega-3 Fatty Acids: Omega-3 fatty acids may help reduce inflammation and protect muscle mass.
- Creatine: Creatine may support muscle energy and mass during recovery, though evidence in surgical settings remains mixed.
Why It Matters
This review examines the role of preoperative nutritional optimization in improving outcomes for patients undergoing orthopedic surgery. The authors highlight how surgical stress induces a hypermetabolic, catabolic state that increases infection risk, muscle wasting, delayed healing, and extended recovery if patients are malnourished or poorly nourished before surgery.
Up to 50% of patients undergoing total joint arthroplasty meet the criteria for malnutrition prior to surgery. The review also notes that patient nutritional needs before and after surgery have often been overlooked in standard guidelines, despite their direct impact on recovery outcomes.
Clinical Implications
- Elective Surgery: Detailed presurgery nutritional assessment and tailored interventions should begin well before the surgery date.
- Urgent Surgery: When time is limited, targeted and rapid nutritional support is recommended. Early postoperative feeding within 4 hours, if medically stable, may help preserve lean body mass and shorten hospital stays.
Limitations
This protocol represents an ideal standard of care but may not be feasible for all patients due to limitations in insurance coverage for medical nutrition therapy services, as well as access to supplements, protein, and other nutritional resources necessary to optimize surgical recovery.
Integration of a Registered Dietitian should also include a clear and actionable plan for follow-up on abnormal laboratory results to ensure adequate time for targeted nutritional interventions.
Final Thoughts
Optimizing nutrition ahead of orthopedic surgery can improve metabolic resilience, reduce complications, and support better recovery. Integrating standardized nutritional screening and Registered Dietitian-led interventions into perioperative care could help fill a major gap in current practice and improve patient outcomes.
Utilizing platforms such as Mend’s Upgraid can help identify and address malnutrition prior to surgery by connecting patients with a Care Team that includes Registered Dietitians, providing access to high-quality supplementation to support recovery, and extending support beyond the surgeon’s office both before and after surgery.
Want to learn more about Upgraid or Mend’s products? Contact us at support@mend.me
This article was written by Katie Frushour, MS, RD, CSSD, a dietitian at Mend.
