ART Score: References
Last updated: Sept 12, 2025
This page lists (A) the core references by variable (these match what’s cited in-app: up to 3 per variable, prioritized by impact on our odds ratios and scale), and (B) the extended bibliography we consulted while building the score.
Glycemic control (Fructosamine)
Shohat N, Tarabichi M, Tan TL, et al. Fructosamine is a better glycaemic marker compared with HbA1c in predicting adverse outcomes following total knee arthroplasty: a prospective multicentre study. Bone Joint J. 2019;101-B(Suppl C):3–9.
Shohat N, Goswami K, Breckenridge L, et al. Fructosamine as a valuable marker of glycemic control to predict adverse outcomes after total hip arthroplasty. Sci Rep. 2021;11:2227.
Tan TL, et al. (Fructosamine & arthroplasty outcomes) — used for triangulation.
Hemoglobin (sex-specific thresholds)
Telang S, et al. (Sex-specific preop anemia & arthroplasty outcomes). J Bone Joint Surg Am. 2020.
Blevins K, et al. Malnutrition and development of periprosthetic joint infection in elective TJA. J Arthroplasty. 2018;33(9):2971–2975.
Gu A, et al. Increased severity of anaemia is associated with 30-day complications following total joint replacement. Bone Joint J. 2020;102-B:485–494.
Total lymphocyte count (TLC)
Morey VM, et al. Albumin and TLC as surrogates for malnutrition to predict wound complications after TKA. J Arthroplasty. 2016;31(6):1317–1321.
Haines KL, et al. Predicting complications in arthroplasty using lymphocyte counts. Nutr Clin Pract. 2012;27(2):177–184.
Mbagwu C, et al. Preop albumin, transferrin, and TLC as risk markers: a systematic review. JAAOS Glob Res Rev. 2020;4(9):e19.0005.
Transferrin & Prealbumin
Roche M, Law TY, Kurowicki J, et al. Albumin, prealbumin, and transferrin may be predictive of wound complications following TKA. J Knee Surg. 2018;31(10):946–951.
Takemoto E, Chen Y, Gometz A, et al. Preop prealbumin & transferrin and 30-day risk in elective spine surgery. Medicine (Baltimore). 2019;98(5):e14322.
Mbagwu C, et al. JAAOS Glob Res Rev. 2020;4(9):e19.0005. (systematic review across markers)
Body mass index (BMI)
Agarwal AR, Harris AB, et al. A novel SSLR method for BMI thresholds and 30-day major complications in TKA (n=443,157). J Arthroplasty. 2023;38:1032–1036.
Harris AB, et al. SSLR BMI thresholds for THA (national cohort). J Arthroplasty. 2022;37:2049–2052.
Rubin J, Potluri AS, Jan K, et al. Systematic review/meta-analysis: morbid obesity (≥40) ~4.3× PJI risk after THA. JAAOS Glob Res Rev. 2025;9(4):e24.
Vitamin D
Kenanidis E, Kakoulidis P, Karponis D, Tsiridis E. Periop vitamin D and infection risk following hip/knee arthroplasty: systematic review. Patient Relat Outcome Meas. 2020;11:161–171.
Arshi A, et al. Preop vitamin D repletion in TKA: cost-effectiveness model. J Arthroplasty. 2020;35(5):1379–1383.
Vivek K, et al. Vitamin D and arthroplasty outcomes (review). JBJS Rev. 2024;12(4):e23.00150.
Smoking
Matharu GS, et al. Smoking status and outcomes after arthroplasty. Acta Orthop. 2019;90(6):559–567.
Koschmeder A, et al. Smoking and PJI/readmission in TJA. Arthroplasty Today. 2023.
(Optional supportive) Larger registry/meta-analyses cited in extended list below.
BMI (supporting/legacy/contexts)
Malinzak RA, Ritter MA, et al. Morbid obesity and deep infection risk (>50). J Arthroplasty. 2009.
Winiarsky R, Barth P, Lotke P. Morbid obesity and TKA outcomes. JBJS Am. 1998.
Alvi HM, Mednick RE, et al. Effect of BMI on 30-day outcomes after TJA. J Arthroplasty. 2015;30:1113–1117.
Lübbeke A, et al. BMI thresholds & increased PJI risk after primary TJA. Acta Orthop. 2016;87:132–138.
Glycemic control
(See Shohat 2019; 2021 above).
Nutrition / immune status (prealbumin, transferrin, TLC)
Greene KA, Wilde AH, Stulberg BN. Preop nutritional status & wound infection in orthopedics. Clin Orthop Relat Res. 1991;(271):139–142.
Savio GCD, Zelicof SB, Wexler LM, et al. Preop nutritional status & THA outcomes. Clin Orthop Relat Res. 1996;(326):153–161.
Nelson CL, Kamath AF, et al. Serum albumin threshold (3.0 g/dL) and complications after THA. Hip Int. 2019;29(2):166–171.
Golladay GJ, Satpathy J, Jiranek WA. Patient optimization strategies that work: malnutrition. J Arthroplasty. 2016;31(8):1621–1624.
Vitamin D
Additional mechanistic and outcome-oriented papers as cataloged in Kenanidis et al. (2020) and JBJS Rev. (2024).
Smoking
Additional registry/meta-analyses linking current smoking to infection, revision, and readmission after TJA (listed in our manuscript reference set).
Citation style: We follow numbered in-text citations in the manuscript (Journal of Arthroplasty style). The app lists up to 3 core references per variable (also listed above), while this page includes both those and the extended bibliography.
Methodology: Available on the Methodology tab.
Calculator: A hosted calculator link is available on the ART Score Calculator tab.