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

Patients with hypoalbuminemia, (serum albumin (SA) < 3.5 g/dL) are at greater risk for complications after surgery, including increased postoperative infection rates after total knee arthroplasty (TKA). This study aimed to analyze both preoperative and postoperative SA in patients who experienced acute periprosthetic infection within the first 4 weeks after surgery.

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 (SA_1W) to evaluate SA dynamics. Multiple patient and operative parameters that could influence SA were also analyzed.

No statistical differences were found in parameters expected to influence SA values between the surgically treated (STG) and non-treated groups (non-STG). None of the patients in STG had SA₀ and SA_1W below 3.5 g/dL. However, the amount and rate of SA reduction before and after surgery were significantly greater in STG than in non-STG.

SA dynamics revealed a greater reduction in both the amount and rate in STG before and after surgery than in non-STG. No correlation was found between early acute periprosthetic infection after TKA and each SA₀ and SA_1W time point. Further evaluation of the SA value of 3.5 g/dL as a threshold for acute early acute infection is warranted.