Perioperative nutrition in musculoskeletal surgeries and procedures has now officially become a "hot topic" and reached an inflection point. From ambivalence or casual curiosity when I started my business thesis in 2013 to JBJS publishing multiple times on perioperative nutrition and leading surgeons now calling it "negligent not to utilize." It has taken a lot of patience, persistence, and work to overcome skepticism and doubt.
Medicine is a deeply entrenched and structured system, and changing behavior or core practice requires a significant effort. It is a conservative domain that is risk-averse and waits patiently for strong evidence and scientific validation before new tools, technologies, or methods are fully embraced. But we are finally here, and I am thrilled to see this shift from early adopters to mainstream use and standard of care. The evidence is now too established and compelling, and too many prominent surgeons have taken up the cause for the momentum to stop.
There is still more work ahead, but the progress is undeniable and the trajectory will accelerate. Imitators will enter (as they already have), capital will flow in, and the space will move toward rapid adoption and deployment. Mend will continue to take a long-term view and lead with science, quality, and value to the patient, which are the three core pillars of our design and development philosophy.
While perioperative nutrition is becoming established in enhancing surgical recovery, the postoperative musculoskeletal patient remains at risk for muscle catabolism, systemic inflammation, and functional decline long after discharge. This is an area I have emphasized almost as long as perioperative nutrition (just ask the physical therapy leaders I have been nudging for a decade) and have structured our portfolio of nutritional interventions to address. It is now time to push postoperative maintenance nutrition through the same arc of adoption, hopefully with less skepticism and a faster path to incorporation in patient care.
In this blog post, I will review the rationale and evidence that long-term maintenance nutrition—targeting muscle, inflammation, and tissue health—improves outcomes, reduces disability risk, lowers healthcare costs, and enhances both the patient experience and the business model.
Key Points
- Nutritional therapy should not end at the immediate postoperative stage.
- Long-term protocols help preserve muscle, improve mobility, reduce chronic pain and inflammation, and lower the risk of long-term disability.
- Evidence supports specific nutrients with clinically meaningful effects on outcomes.
- Utilizing nutrition in this way enhances long-term patient health and outcomes while also improving revenue and profitability.
The Need Beyond the Perioperative Window
We often emphasize perioperative nutrition during the immediate pre- and postoperative period and through formal rehabilitation, but once patients are discharged, nutrition frequently fades from the treatment plan. The reality is that recovery extends far beyond that point, and wellness is a lifelong pursuit. Without continued nutritional support, patients remain vulnerable to persistent catabolism, chronic inflammation, and comorbidities that can derail long-term outcomes.
Quadriceps atrophy after knee replacement, for example, can persist for more than a year if not nutritionally addressed, leaving patients weaker and less mobile. Markers of systemic inflammation such as CRP and IL-6 can remain elevated for weeks to months after surgery, prolonging stiffness, pain, and delayed rehabilitation. For patients with diabetes, obesity, or sarcopenia, the risks are even higher, leading to more complications, readmissions, and lasting disability when these challenges are left unaddressed. This “recovery gap” is where maintenance nutrition must step in.
Long-term nutritional strategies that target muscle preservation, inflammation control, and tissue healing can significantly improve functional outcomes, reduce disability, and lower healthcare costs. Mend has incorporated each of the compounds below into a thoughtfully designed set of evidence-based products for maintenance and long-term health. I have created a concept called "EWAS"—to advance from "enhanced recovery" to "enhanced wellness after surgery"—which aligns with the belief that surgery can serve as a gateway to behavioral change and improved well-being.
Muscle Preservation
Guidelines from ESPEN and the PROT-AGE Study Group emphasize the importance of higher daily protein intake (1.2 to 1.5 g/kg/day) to maintain lean mass and improve rehabilitation outcomes. Supplementation with leucine and essential amino acids has been shown in randomized trials to stimulate muscle protein synthesis even in older adults when used to address anabolic resistance. Other compounds such as HMB and creatine offer additional support: HMB reduces muscle loss and improves strength recovery during immobilization, while creatine accelerates strength gains and may enhance bone mineral density.
Inflammation and Joint Protection
Chronic inflammation is one of the biggest barriers to full recovery. Targeted nutrition plays a key role here as well. Products like Perform by Mend → combine clinically studied ingredients such as omega-3s and curcumin to help modulate inflammatory markers like CRP and IL-6, improving recovery and reducing chronic pain. Curcumin, studied extensively in osteoarthritis, reduces pain and stiffness and in some trials performs comparably to NSAIDs. Anthocyanin-rich foods such as berries help reduce post-exercise inflammation and improve mobility, while collagen peptides contribute to joint and connective tissue health.
Functional and Quality-of-Life Outcomes
The impact of long-term nutrition is not only biochemical but also functional. In hip fracture patients, nutrition supplementation reduced complications by 34% and lowered mortality by 20%. In arthroplasty patients, continued protein and EAA supplementation improved strength and functional scores at 3 months, 6 months, and even 2 years. Among older adults at risk for sarcopenia, ongoing nutritional support reduced hospital readmissions and preserved independence. These are not small effects; they represent tangible gains in mobility, quality of life, and independent living.
The Framework for Product Design
We utilize Mend Regenerate and Perform Daily Inflammation for postoperative long-term musculoskeletal maintenance and have additional products targeting factors that drive poor health, such as high blood sugar. A structured framework makes long-term nutrition actionable in daily practice. The foundation is sufficient protein intake (1.2 to 1.5 g/kg/day), distributed in leucine-rich formulations, paired with creatine to support muscle recovery and bone health, and vitamin D with calcium to ensure skeletal integrity. Inflammation control is maintained with daily curcumin, tart cherry, and ginger. Absorption is enhanced through the use of digestive enzymes and prebiotics, which are especially important for older adults with reduced gut absorption efficiency. These nutritional strategies integrate seamlessly with lifestyle interventions such as resistance training, balance and mobility work, and management of metabolic conditions like diabetes and obesity.
Implications for Orthopedic Practice
The evidence and implications are clear: a full recovery and return to wellness is a continual process, and attention to nutrition should be as well. Long-term nutritional strategies sustain muscle preservation, reduce chronic pain, and accelerate return to mobility. For practices, the benefits extend beyond clinical outcomes: fewer readmissions, lower rehabilitation costs, reduced long-term disability, enhanced patient satisfaction, and a new revenue stream that can be implemented easily without additional burden for the surgeon. Integrating maintenance nutrition not only elevates patient care but also positions orthopedic practices as leaders in comprehensive musculoskeletal health.
Perioperative nutrition has moved from skepticism to mainstream acceptance and is now on the path to becoming standard of care in musculoskeletal surgery. The next frontier is long-term maintenance nutrition. By extending nutritional therapy into long-term wellness, we can reduce complications, enhance recovery, and give patients the gift of sustained independence. Nutrition is not a side note to surgical care—it is an evidence-based and logical extension into lifelong musculoskeletal resilience.
This article was written by Eziah Syed, Co-Founder, Chief of Growth & Innovation at Mend.
