Preoperative nutritional status and outcome of elective total hip replacement.

Preoperative malnutrition increases the morbidity rate and length of hospitalization for various types of surgical patients. However, among patients who undergo elective total hip replacement, it is unclear how preoperative nutritional data can be used to detect a high risk subgroup. The purpose of this study was to identify preoperative nutritional factors that could be used to define a subgroup of patients who have undergone elective total hip replacement who are at high risk for poor post-operative outcome. Preoperative nutritional factors were evaluated in 89 consecutive patients who underwent elective total hip replacement. An inverse relationship was found between serum albumin and length of stay. Patients with an albumin level less than 3.9 were twice as likely to require prolonged hospitalization ( > 15 days) when compared with those in whom the albumin level was 3.9 or greater. Complications were related to the preoperative orthopaedic diagnosis of avascular necrosis of the hip. A subgroup of the patients undergoing elective total hip replacement who are at risk for prolonged recovery can be identified preoperatively by using a serum albumin level of less than 3.9 g/dL. The traditional normal range for albumin may be inappropriate for these patients.

Interdigital neuroma. Local cutaneous changes after corticosteroid injection.

Interdigital neuroma was diagnosed in a patient who was treated subsequently with a local corticosteroid injection. Two to 3 weeks after injection, a 2.5 x 1.5-cm area of hyperpigmentation, thinning of the skin, and subcutaneous fat atrophy developed at the site of the injection. Occurrence of these side effects depends on the solubility of the steroid preparation, the dosage, and the anatomic site and depth of the injection. When using local corticosteroid injections to treat interdigital neuromas, the physician should be familiar with the properties and recommended dosage of the given steroid. The injection should be deep enough so that the cortisone solution does not leak into the subcutaneous area. The possibility of skin atrophy and altered pigmentation should be discussed with all patients.