ABSTRACT
The physiological stress of major surgical procedures has been thoroughly reviewed and there have been robust studies of the influence of metabolic therapy in general surgical procedures, and outcome measures beyond the length of stay (LOS) and readmission rates are being evaluated in the current literature. This chapter hones the general surgery research to orthopedic application. It details clinical and immediate metabolic therapy strategies to support patients undergoing orthopedic surgery. Orthopedic procedures occur disproportionately among patients with preexisting deconditioning, sarcopenia, and/or obesity. Implementing metabolic therapy for pain management takes time, some patience, and patient education. Glutamine is the most abundant free amino acid in the cytosol and during stress it constitutes 70% of amino acids released by skeletal muscle, and provides metabolic fuel to T-lymphocytes, enterocytes, and other rapidly proliferating cells.
