hypoalbuminemia increases mortality after two-stage revision total joint arthroplasty

Objectives: this study aimed to evaluate the effect of hypoalbuminemia on failure rates and mortality after a two-stage revision for pji.methods: 199 patients (130 knees and 69 hips) with a mean age of 64.7 ± 10.7 years who underwent a two-stage exchange were retrospectively reviewed at a mean of 51.2 ± 39.7 months. failure of treatment was defined as any revision within the follow-up period, failure to undergo reimplantation, or death within one year of initiating treatment.results: there were 71 failures (35.7%), including 38 septic failures (19.1%). we found no differences between successful revisions and failures regarding hypoalbuminemia (43% vs. 42% prior to stage 1, p=1 and 32% vs. 29% prior to stage 2, p=0.856). there were also no differences in hypoalbuminemia rates between septic failures and the rest of the cohort (42% vs. 43% prior to stage 1, p=1.0 and 34% vs. 30% prior to stage 2, p=0.674). hypoalbuminemia prior to stage 2 was a significant predictor of mortality based on multivariate analysis (odds ratio 5.40, ci 1.19-24.54, p=0.029). hypoalbuminemia was independently associated with a greater length of stay by 2.2 days after stage 1 (p=0.002) and by 1.0 days after the second stage reimplantation (p=0.004).conclusion: preoperative hypoalbuminemia is a significant predictor of mortality and increased length of stay following two-stage revision but is not a predictor of failure of pji treatment. further study is required to understand if hypoalbuminemia is a modifiable risk factor or a marker for poor outcomes.