IronSucrosomial ferric pyrophosphate (30 mg) plus L-ascorbic acid (70 mg)Briguglio et al. [16]RCTN = 73, 67.3 ± 8.6.
Intervention group: N = 37, Control group:
N= 36AnemiaOlder patients with no support lost −2.8 ± 5.1%, while the intervention group gained +0.7 ± 4.6% circulating hemoglobin from baseline (p = 0.019)After 30 days of oral iron plus L-ascorbic acid therapy, no significant changes in the martial status were observed after treatment.Ferric carboxymaltose
1000 mg (body weight ≥ 50 kg)
Ferric carboxymaltose 500 mg (body weight < 50 kg)
For 1 day before and 3 days after surgeryChoi et al., 2022 [19]RCT110 pt, Intervention group: N = 54, 71.4 ± 5.7
Control group: N = 55, 71.8 ± 6.2Hb and iron response, QoLThe FCM group demonstrated a significantly greater number of Hb responders (p < 0.001) and a higher Hb level (p = 0.008) at 2 weeks postoperatively.In postoperative anemia, a single infusion of 5000 and 1000 mg ev of ferric carboxymaltose increases the Hb response and improved Hb and iron metabolism variables. However, intervention did not affect the transfusion rate or QOL.Ferrous sulphate
(200 mg, containing 65 mg of elemental iron) 3 times daily for 3 weeksMundy et al., 2005 [22]RCT31 pt, Intervention group: N = 18, 67.8 ± 10.5
Control group: N = 13, 67.0 ± 9.4Hemoglobin and absolute reticulocyte countAdministration of iron supplements after elective total hip or total knee arthroplasty does not appear to be worthwhile.Administration of iron supplements after elective total hip or total knee
arthroplasty does not appear to be worthwhile.Iron isomaltoside administered 30 min during surgical wound closure.Yoo et al., 2021 [28]RCT89 pt
Intervention group N = 44
71 ± 6
Control group
N = 45
70 ± 7HbThe incidence of anemia at 30 days after surgery was significantly lower in the treatment group (p = 0.008)The intra-operative administration of iron isomaltoside effectively prevents postoperative anemiaDaily doses of rhEPO combined with iron supplementCao et al., 2020 [18]RCT102 pt Group A: rhEPO + iron (3 days before surgery), Group B: rhEPO + iron (day of surgery), Group C: iron aloneHb, blood loss, reticulocyte levels, complicationsPatients in Group A had significantly lower total blood loss than Groups B and C (A vs. B: p = 0.010; A vs. C: p < 0.001). Group A patients had significantly smaller Hb decline than Group C on the third and fifth postoperative days (p = 0.049, p = 0.037), as well as than Group B on the fifth postoperative day (p = 0.048)Daily dose of rhEPO combined with iron supplement administered 3 days before TKA procedures could significantly decrease perioperative blood loss and improve postoperative Hb levels, without significantly elevating risks of complicationsGlucosamine sulphateOral glucosamine sulphate 1500 mg once-a-day for at least 12 months and up to 3 years.Bruyere et al., 2008 [17]RCT275 pt, Intervention group: N = 144, 62.9 ± 7.6
Control group: N = 131, 63.6 ± 6.6Number of knee arthroplastiesA significantly decreased (p = 0.026) cumulative incidence of total knee replacements in patients who had received glucosamine sulphate.Treatment of knee OA with glucosamine sulphate for at least 12 months and up to 3 years may prevent surgeryEssential Amino Acids20 g of EAA
Twice daily between meals for
1 week before and 2 weeks after
surgery.Dreyer et al., 2013 [20]RCT28 pt, Intervention group: N = 16, 68 ± 5
Control group: N = 12, 70 ± 5Muscle atrophy, muscle strength, and functional mobilityPatients receiving placebo exhibited greater quadriceps muscle atrophy, 2 weeks (p = 0.036) and 6 weeks after surgery (p = 0.001)EAA treatment attenuated muscle atrophy and accelerated the return of functional mobility in older adults following surgeryEAA
20 g of EAA
twice-daily, for 7 days before and for 6 weeks after surgeryMuyskens et al., 2019 [23]RCTN = 41A biopsy during surgery, and two additional biopsies at either 1 or 2 weeks after surgery to study satellite cells and other key histological markers of inflammation, recovery, and fibrosis.L-arginine (Arg; 14,000 mg) and L-glutamine (Gln; 14,000 mg) (HMB/Arg/Gln), Beta-hydroxy beta-methylbutyrate
(HMB; 2400 mg), (158 kcal of energy) for 5 days before the surgery and for 28 days after the surgery. Patients fasted on the day of surgery.Nishizaki et al., 2015 [24]RCTN = 32Body weight, bilateral
knee extension
strength, rectus
femoris
cross-sectional areaThe maximal quadriceps strength was 1.1 ± 0.62 Nm/Kg before surgery and 0.7 ± 0.9 Nm/Kg after surgery 14 days in the control group (p = 0.02), and 1.1 ± 0.3 Nm/Kg before surgery and 0.9 ± 0.4 Nm/Kg after surgery 14 days in the HMB/Arg/Gln group.Consuming HMB/Arg/Gln supplementation may suppress the loss of muscle strength after TKA. Intervention with exercise and nutrition appears to enable patients to maintain their quadriceps strength.Isoleucine (603 mg, 6.7%), leucine (684 mg, 7.6%), lysine (756
mg, 8.4%), methionine (603 mg, 6.7%), phenylalanine (405 mg,
4.5%), threonine (405 mg, 4.5%), tryptophan (207 mg, 2.3%),
valine (603 mg, 6.7%), arginine (630 mg, 7%), histidine (315 mg, 3.5%), and starch (1089 mg, 12.1%)
From 1 week prior to surgery until 2 weeks after it.
3 times daily (after every meal) for a total of 9 g/day.Ueyama et al., 2020 [25]RCT60 pt
Intervention group N = 30
75.9
Control group
N = 30
75.8Rectus femoris muscle areaImprovement of VAS (p = 0.038), albumin level (p = 0.009), quadriceps area (p = 0.026), muscle diameter (p = 0.029)
after 4 weeks from surgeryPerioperative essential amino acid supplementation prevents rectus femoris muscle atrophy and accelerates early functional recovery after surgeryThreonine (405 mg, 4.5%), lysine (756 mg, 8.4%), isoleucine (603 mg, 6.7%), valine (603 mg, 6.7%), methionine (603 mg, 6.7%), tryptophan (207 mg, 2.3%), phenylalanine (405 mg, 4.5%), leucine (684 mg, 7.6%), histidine (315 mg, 3.5%), arginine (630 mg, 7%), and glycine (1089 mg, 12.1%); the remainder was starch (2700 mg, 30%).Ueyama et al., 2023 [26]RCT52 pt
Intervention group N = 26
76.4 ± 8.3
Control group
N = 26
75.2 ± 5.5Rectus femoris muscle areaImprovement in rectus muscle area (p = 0.02, p = 0.01), diameter (p = 0.009) after 1 year and 2 yearsPerioperative EAA supplementation contributes to the recovery of rectus femoris muscle volume and quadriceps muscle strength in the 2 years after surgeryVitamin D350,000 international units vitamin D3 on the morning of surgeryWeintraub et al., 2023 [27]RCT107 pt
Intervention group N = 57
63.7 ± 9.5
Control group
N = 50
64.5 ± 63.7KSS, TUGThere was no difference in improvement in KSS at 3 weeks (p = 0.6) or 6 weeks (p = 0.5) from baseline. There was no difference in change in TUGT at 3 weeks (p = 0.6) or 6 weeks (p = 0.6) from baseline.Supplementation with vitamin D3 on the day of surgery failed to demonstrate statistically significant differences in functional KSS, TUGT times, or complications in the early postoperative period compared to placebo.Adenosine 5′-triphosphate supplementationATP
20 mg ATP for 4 weeksLong and Zhang, 2014 [21]RCT232 pt, Intervention group: N = 119, 60.1 ± 4.5
Control group: N = 113, 58.9 ± 5.2Quadriceps strength, pain scoresReduction in length of hospitalization (p = 0.0027) and analgesic consumption (p = 0.021)Oral supplement of ATP could benefit patients recovering from knee arthroplasty