Peri-operative nutrition in femoral neck fracture arthroplasty: a pragmatic framework to mitigate dual-hit catabolism and improve outcomes

Femoral neck fracture patients represent one of the most metabolically vulnerable populations undergoing total hip arthroplasty, with malnutrition prevalence frequently exceeding 40–50%. • Acute trauma, enforced fasting, inflammation and comorbidity amplify the surgical stress response, accelerating protein catabolism, immune dysfunction and muscle loss. • Malnutrition in femoral neck fracture patients is independently associated with increased mortality, infection, prolonged hospital stay, delayed mobilisation and institutionalisation. • Unlike elective arthroplasty, opportunities for pre-operative optimisation are limited, making early identification and aggressive peri-operative nutritional support critical. • A phase-specific nutritional framework—focused on rapid screening, intra-operative metabolic protection and early post-operative feeding—offers a pragmatic, low-cost strategy to improve outcomes, particularly in LMIC settings.