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Late Infection in Scoliosis: A Meta-Analysis

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Review Article | Journal of Clinical Orthopaedics | Vol 10 | Issue 2 | July-December 2025 | page: 61-69 | Vishal Kumar, Manuj Jain, Aditya Gupta, Arvind Vatkar, Deepshikha, Sarvdeep Singh Dhatt, Sachin Kale

DOI: https://doi.org/10.13107/jcorth.2025.v10.i02.778

Open Access License: CC BY-NC 4.0

Copyright Statement: Copyright © 2025; The Author(s).

Submitted Date: 02 Oct 2025, Review Date: 20 Oct 2025, Accepted Date: 23 Nov 2025 & Published Date: 10 Dec 2025

Author: Vishal Kumar [1], Manuj Jain [4], Aditya Gupta [1], Arvind Vatkar [2], Deepshikha [3], Sarvdeep Singh Dhatt [1], Sachin Kale [5]

[1] Department of Orthopaedics, Postgraduate Institute of Medical Education and Research, Chandigarh, India,
[2] Department of Orthopaedics, Base Hospital, Bagdogra, West Bengal, Department of Orthopaedics,
[3] MGM Medical College, Mumbai, Maharashtra, India,
[4] Department of Physical Medicine and Rehabilitation, Postgraduate Institute of Medical Education and Research, Chandigarh, India,
[5] Department of Orthopaedics, Dr D Y Patil School of Medicine, Mumbai, Maharashtra, India.

Address of Correspondence

Dr. Vishal Kumar,
Department of Orthopaedics, Postgraduate Institute of Medical Education and Research, Chandigarh, India,
E-mail: drkumarvishal@gmail.com

Abstract

This meta-analysis aims to evaluate the incidence, risk factors, and clinical outcomes of late infections in scoliosis patients following spinal instrumentation. A systematic review of studies indexed in PubMed, Embase, and Scopus databases was conducted. Studies that focused on scoliosis patients with late-developing infections, particularly after surgical treatment involving spinal instrumentation, were included. Data on infection rates, risk factors such as patient age and comorbidities, surgical techniques, and clinical outcomes were extracted and analyzed. Statistical methods, including pooled incidence rates and subgroup analysis, were used to assess the significance of the findings. The incidence of late infections varied significantly across different scoliosis types, with idiopathic scoliosis showing lower infection rates compared to neuromuscular scoliosis. Key risk factors identified included the duration of surgery, the use of prophylactic antibiotics, and patient comorbidities, particularly obesity. Late infections were often associated with a higher rate of reoperations, hardware removal, and prolonged antibiotic therapy. Late infections following spinal instrumentation in scoliosis patients remain a significant concern, with certain patient populations at higher risk. Early detection and preventive strategies are essential to mitigate these risks and improve clinical outcomes. Future research should focus on standardizing infection prevention protocols and long-term monitoring of scoliosis patients post-surgery.
Keywords: Late infection, scoliosis, spinal instrumentation, meta-analysis, risk factors, post-operative complications, neuromuscular scoliosis, idiopathic scoliosis.

References

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How to Cite this Article: Kumar V, Jain M, Gupta A, Vatkar A, Deepshikha, Dhatt SS, Kale S. Late Infection in Scoliosis: A Meta-Analysis. Journal of Clinical Orthopaedics. July-December 2025;10(2):61-69.

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Is Potential Malnutrition Associated with Increased Morbidity in Total Hip and Knee Joint Arthroplasty? A Prospective Cohort Study

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Journal of Clinical Orthopaedics | Vol 9 | Issue 1 |  January-June 2024 | page: 04-09 | William James Caughey, Faseeh Zaidi, Christoper Jarred Shepherd, Claudia Rivera-Rodriguez, Rocco P Pitto

Open Access License: CC BY-NC 4.0

Copyright Statement: Copyright © 2024; The Author(s).

DOI: https://doi.org/10.13107/jcorth.2024.v09i01.620

Author: William James Caughey [1,2], Faseeh Zaidi [1,2], Christoper Jarred Shepherd [1], Claudia Rivera-Rodriguez [3], Rocco Paolo Pitto [1,2]

[1] Department of Orthopaedic Surgery, Middlemore Hospital, Auckland, New Zealand,
[2] Department of Surgery, University of Auckland, Auckland, New Zealand,
[3] Department of Statistics, University of Auckland, Auckland, New Zealand.

Address of Correspondence
William James Caughey,
Department of Orthopaedic Surgery, Middlemore Hospital, Auckland, New Zealand.
E-mail: wjcaughey@gmail.com

Abstract

Introduction: Malnutrition is considered a risk factor for post-operative complications in total hip and knee arthroplasty, though prospective studies to investigate this assumption are lacking. The aims of this study were to prospectively analyze the 90-day post-operative complications, post-operative length of stay (LOS), and readmission rates of patients undergoing primary total hip and total knee arthroplasty using albumin, total lymphocyte count (TLC), and transferrin as serum markers of potential malnutrition.
Materials and Methods: Six hundred and three primary hip and 823 primary knee arthroplasties over a 3-year period from a single center were prospectively analyzed. Body mass index, demographic, and comorbidity data were recorded. Complications were categorized as surgical site infection (SSI), venous thromboembolism (VTE) (deep vein thrombosis and pulmonary embolus), implant-related (such as dislocation), and non-implant-related (such as pneumonia). Outcomes were compared between groups, with malnutrition, defined as serum albumin <3.5 g/dL.
Results: Potential malnutrition was present in 9.3% of the study population. This group experienced a longer average LOS at 6.5 days compared to the normal albumin group at 5.0 days (P = 0.003). SSI rate was higher in the malnourished group (12.5 vs. 7.8%, P = 0.02). There was no difference between the two groups in implant-related complications (0.8 vs. 1.0%, P = 0.95) medical complications (7.8 vs. 13.3%, P = 0.17), rate of VTE (2.3 vs. 2.7%) or 90-day readmission rate (14.1 vs. 17.0%, P = 0.56). TLC and transferrin were not predictive of any of the primary outcomes measured (P > 0.05). Pacific Island (P < 0.001), Indian (P = 0.02), and Asian (P = 0.02) patients had lower albumin than NZ European.
Conclusion: This study demonstrates an association between low albumin levels and increased post-operative LOS and SSI in total joint arthroplasty, providing support for the consideration of pre-operative nutritional screening.
Keywords: Knee arthroplasty, hip arthroplasty, malnutrition, post-operative complications, hypoalbuminemia.

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How to Cite this article: Caughey WJ, Zaidi F, Shepherd CJ, Rivera-Rodriguez C, Pitto RP. Is Potential Malnutrition Associated with Increased Morbidity in Total Hip and Knee Joint Arthroplasty? A Prospective Cohort Study. Journal of Clinical Orthopaedics 2024 January-June;9(1):04-09.

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