# Patient Perceptions of Orthopedic Surgeon-Led Nutrition Discussions Regarding Arthroplasty Care: A Single-Center Retrospective Study

## TL;DR

This study shows that many patients believe talking to their orthopedic surgeon about nutrition before arthroplasty surgery helps improve their care, but more research is needed to confirm actual benefits.

## Contribution

This is the first study to explore patient perceptions of orthopedic surgeon-led nutrition discussions in arthroplasty care.

## Key findings

- Most patients (87%) reported that surgeon-led nutrition counseling positively impacted their care.
- 78.1% of patients wanted their surgeon to discuss nutrition.
- The study highlights the need for further multicenter research to assess clinical benefits.

## Abstract

Background: Nutrition and lifestyle factors, such as low albumin, smoking, and morbid obesity, have been linked to worse outcomes after arthroplasty surgery. This study is the first, to our knowledge, to investigate the effect of orthopedic surgeon-led nutrition discussions on patient perceptions in arthroplasty care. The primary objective of this study was to describe patient perceptions and self-reported experiences regarding nutrition counseling provided directly by their orthopedic surgeon in the context of arthroplasty care. Secondary objectives were to assess the following: (1) patient recall of receiving nutrition guidance; (2) the perceived benefit of this counseling on their surgical preparation and recovery; and (3) patient attitudes toward surgeon-led nutrition discussions.

Methods: In this retrospective study, patients who underwent hip, knee, or both hip and knee arthroplasty between 2004 and 2024 at a single-center private practice orthopedic group were surveyed regarding nutrition counseling. A chart review assessed for complications, comorbidities, and surgical outcomes. A subgroup analysis was performed to evaluate whether patient age differed between those who reported adopting a low-carbohydrate diet based on their surgeon's guidance and those who did not. Mean ages were compared using a Welch two-sample t-test with significance set at p < 0.05. Additional categorical subgroup analyses were performed to determine the difference in infection status based on smoking status (Fisher's exact test), age (Welch two-sample t-test), and alcohol use (Cochran-Armitage trend test). Importantly, this study is unable to analyze associations with complications due to an insufficient event rate. Note that several of the optional questions only had 146 responses, so those questions were not included in the statistical analysis.

Results: A total of 152 patients responded to the survey (not all questions had responses), representing a total of 190 primary arthroplasty procedures and three revisions. Of these, 114 patients (78.1%) reported they wanted their orthopedic surgeon to discuss nutrition, 17 (11.6%) were unsure, and 15 (10.3%) did not. Most patients (n = 127; 87%) indicated that surgeon-led nutrition counseling positively impacted their care, while 12 (8.2%) were unsure, and seven (4.8%) reported no benefit.

Conclusion: This study demonstrated patient-perceived benefits of surgeon-led nutrition counseling in arthroplasty care. These findings highlight the potential value of incorporating nutrition discussions into the surgical care pathway. However, this study is not able to assess objective clinical benefits due to limitations in the study design. This study only provides preliminary, hypothesis-generating data on patient attitudes, not evidence of efficacy or benefit. Given the single-center, retrospective design and limitations of this study, further multicenter investigations are warranted to assess outcomes and inform standardized guidelines.