Newton Wellesley Orthopedic Associates, Inc.

➤ Malnutrition is common among subsets of patients undergoing orthopaedic surgery and is associated with an increased risk of postoperative complications.➤ Serum proteins, in particular, albumin, may be used in the evaluation of nutritional status.➤ Anthropometric measurements and surveys also play a role in the evaluation of nutritional status.➤ Increased energy and nutrient requirements due to surgical procedures necessitate increased caloric and protein intake in the perioperative period, which may be achieved through diet or supplementation.➤ Evidence supports the use of protein-calorie, amino acid, and immunonutrition supplements. Vitamin D supplementation is an area of further consideration.➤ Diet restriction, activity alterations, pharmacotherapy, and bariatric surgery are all safe, effective approaches to weight loss, although the optimal timing and magnitude of preoperative weight loss require further investigation.

Radiographic measurement of patient-specific spinopelvic mobility is standard-of-care in total hip arthroplasty (THA). Current manual methods are time-consuming, subjective, and error-prone. This study utilized deep learning (DL) to classify functional positions and measure pelvic tilt (PT), sacral slope (SS) and lumbar lordotic angle (LLA). A DL pipeline integrating image classification, vertebra detection, and landmark detection was developed using data from an international joint registry, comprising 52,772 images for classification, 9,875 for object detection, and 25,249 for landmark detection. Performance was evaluated using area under the curve (AUC), F1 score, and mean absolute error (MAE). Accuracy was compared to annotations by three expert engineers and validated by two senior engineers and a surgeon. Radiographs were processed in 1.96 ± 0.04 s, achieving precision, recall, Receiver-operator-characteristic-AUC, and Precision-Recall-AUC metrics above 0.994. Anatomical landmark predictions resulted in errors of: PT: 1.6°±2.1°, SS: 3.3°±2.6°, LLA: 4.2°±3.2°. There was no significant difference in PT and LLA between expert engineers and the DL pipeline, and 0.5° difference in SS (p = 0.043). Clinical validation showed no difference in landmark rejection rates (p > 0.05). We developed and clinically validated a DL pipeline that accurately measures patient-specific spinopelvic mobility from lateral functional radiographs, providing a scalable method for routine characterization in THA patients.