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Birinci M, Hakyemez ÖS, Geçkalan MA, Mutlu M, Yildiz F, Bilgen ÖF, Azboy İ. Effect of Vitamin D Deficiency on Periprosthetic Joint Infection and Complications After Primary Total Joint Arthroplasty. J Arthroplasty 2024:S0883-5403(24)00445-5. [PMID: 38734328 DOI: 10.1016/j.arth.2024.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 05/01/2024] [Accepted: 05/01/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND Vitamin D deficiency is a global problem, and 13 to 75% of patients undergoing total joint arthroplasty (TJA) have vitamin D deficiency. Several studies have shown that low preoperative vitamin D levels may increase the risk of postoperative complications, including periprosthetic joint infection (PJI), in patients undergoing primary TJA. Most of the studies are underpowered. This study aimed to investigate the relationship between vitamin D deficiency and surgical and medical complications after primary TJA, with a specific focus on PJI. METHODS Prospectively collected institutional multicenter arthroplasty databases were reviewed to identify patients who underwent primary total knee and hip arthroplasty. The study group was defined as patients whose vitamin D level is < 30 ng/dL and who received a single oral dose of 7.5 mg (300,000 IU) D3 within two weeks before index surgery (n = 488; mean age 63 years). Patients in the control group were those whose preoperative vitamin D levels were unknown and who did not receive vitamin D supplementation (n = 592, mean age 66). The groups were compared regarding 90-day medical and surgical complications, including PJI, mortality, and readmission rates. RESULTS The total number of complications (8.6 and 4.3%; respectively; P = .005), superficial wound infection (2.5 and 0.2%, respectively; P < .001), and postoperative cellulitis (2.2 and 0% respectively; P < .001) were statistically significantly higher in the patient group who did not receive vitamin D supplementation. However, 90-day mortality (P = .524), PJI (P = .23), and readmission rate (P = .683) were similar between the groups. CONCLUSIONS This study demonstrated that preoperative optimization of vitamin D levels may be beneficial in reducing postoperative complications, including superficial wound infection and postoperative cellulitis. Administering an oral 300,000 U single-dose vitamin D regimen to correct vitamin D deficiency can positively impact outcomes following primary TJA.
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Affiliation(s)
- Murat Birinci
- Faculty of Medicine, Department of Orthopaedics and Traumatology, İstanbul Medipol University, İstanbul, Türkiye
| | - Ömer S Hakyemez
- Faculty of Medicine, Department of Orthopaedics and Traumatology, İstanbul Medipol University, İstanbul, Türkiye
| | - Muhammed A Geçkalan
- Department of Orthopaedics and Traumatology, Bezmialem Vakif University, İstanbul, Türkiye
| | - Müren Mutlu
- Department of Orthopaedics and Traumatology, Medicabil Hospital, Bursa, Türkiye
| | - Fatih Yildiz
- Department of Orthopaedics and Traumatology, Bezmialem Vakif University, İstanbul, Türkiye
| | - Ömer F Bilgen
- Department of Orthopaedics and Traumatology, Medicabil Hospital, Bursa, Türkiye
| | - İbrahim Azboy
- Faculty of Medicine, Department of Orthopaedics and Traumatology, İstanbul Medipol University, İstanbul, Türkiye
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Vivek K, Kamal R, Perera E, Gupte CM. Vitamin D Deficiency Leads to Poorer Health Outcomes and Greater Length of Stay After Total Knee Arthroplasty and Supplementation Improves Outcomes: A Systematic Review and Meta-Analysis. JBJS Rev 2024; 12:01874474-202404000-00003. [PMID: 38574186 PMCID: PMC10990007 DOI: 10.2106/jbjs.rvw.23.00150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
BACKGROUND Vitamin D deficiency is increasingly identified as a predictor of poorer outcomes in musculoskeletal disease affecting as many as 1 in 4 people. This study aimed to evaluate the effect of vitamin D supplementation on outcomes after primary total knee arthroplasty (TKA). METHODS A targeted search of terms related to vitamin D and TKA outcomes was performed in PubMed, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, American Academy of Orthopaedic Surgeons, and British Orthopaedic Association databases. The results were analyzed using forest plots with I2 heterogeneity statistics and pooled effects with 95% confidence intervals (CIs) and p values. A p < 0.05 was considered statistically significant. RESULTS A total of 146,054 patients with 150,107 TKRs were analyzed in 10 studies that complied with the inclusion criteria, of which 3 were suitable for meta-analysis. Of these, 4 of the 10 studies showed that vitamin D deficiency resulted in poorer functional outcome scores (Western Ontario and McMasters Universities Osteoarthritis Index, Knee Society Scoring System, and American Knee Society scores), as well as increased risk of revision surgery, incidence of joint infection, and postoperative stiffness. Meta-analysis of length of hospital stay (LOS) demonstrated a significant increase in LOS in patients with vitamin D deficiency (standardized mean difference, -0.54, 95% CI, -0.69 to -0.38, p < 0.00001). Furthermore, outcomes were improved with vitamin D supplementation in 6 of 10 studies. CONCLUSION Vitamin D deficiency results in poorer outcomes of primary TKA, with improved outcomes after supplementation. Further studies should examine the role of preoperative vitamin D screening and/or perioperative supplementation in primary TKA and standardize outcome measures to assess their effect. LEVEL OF EVIDENCE Level I/II. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Kavyesh Vivek
- Department of Surgery and Cancer, Imperial College University, London, United Kingdom
| | - Rayan Kamal
- Department of Surgery and Cancer, Imperial College University, London, United Kingdom
| | - Edward Perera
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Chinmay M. Gupte
- Department of Surgery and Cancer, Imperial College University, London, United Kingdom
- Imperial College Healthcare NHS Trust, London, United Kingdom
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3
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Zink TM, Kent SE, Choudhary AN, Kavolus JJ. Nutrition in Surgery: An Orthopaedic Perspective. J Bone Joint Surg Am 2023; 105:1897-1906. [PMID: 37856576 DOI: 10.2106/jbjs.23.00259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
➤ Malnutrition is common among subsets of patients undergoing orthopaedic surgery and is associated with an increased risk of postoperative complications.➤ Serum proteins, in particular, albumin, may be used in the evaluation of nutritional status.➤ Anthropometric measurements and surveys also play a role in the evaluation of nutritional status.➤ Increased energy and nutrient requirements due to surgical procedures necessitate increased caloric and protein intake in the perioperative period, which may be achieved through diet or supplementation.➤ Evidence supports the use of protein-calorie, amino acid, and immunonutrition supplements. Vitamin D supplementation is an area of further consideration.➤ Diet restriction, activity alterations, pharmacotherapy, and bariatric surgery are all safe, effective approaches to weight loss, although the optimal timing and magnitude of preoperative weight loss require further investigation.
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Affiliation(s)
- Thomas M Zink
- Tufts Medical Center, Boston, Massachusetts
- Tufts University School of Medicine, Boston, Massachusetts
| | - Suzanne E Kent
- Tufts Medical Center, Boston, Massachusetts
- Tufts University School of Medicine, Boston, Massachusetts
| | | | - Joseph J Kavolus
- Tufts University School of Medicine, Boston, Massachusetts
- Newton-Wellesley Orthopedic Associates, Newton, Massachusetts
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Nowak J, Jabczyk M, Jagielski P, Hudzik B, Brukało K, Borszcz J, Zubelewicz-Szkodzińska B. Could vitamin D concentration be a marker of a long hospital stay in older adults patients? Front Nutr 2023; 10:1277350. [PMID: 37927497 PMCID: PMC10622960 DOI: 10.3389/fnut.2023.1277350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 09/21/2023] [Indexed: 11/07/2023] Open
Abstract
Background and aims Vitamin D plays a pleiotropic role in the human body. Some studies have suggested that hypovitaminosis D may serve as a marker of comorbidity severity and length of hospital stay. Hospitalized older adults patients with a higher comorbidity burden tend to have lower vitamin D status, which negatively impacts the length of their hospital stay. Vitamin D deficiency has been identified as a significant risk factor for a prolonged hospital stay. This study aimed to investigate the link between vitamin D status and prolonged hospital stays, focusing on geriatric patients, and to assess the variation in hospitalization duration among geriatric patients with different vitamin D statuses. Methods The study sample comprised of 422 patients aged over 60 years admitted to the geriatric department. Blood samples were collected in the morning on the day of admission. According to the diagnostic threshold defining serum 25(OH)D concentration approved for Central Europe, patients were divided into two groups (deficiency group and suboptimal group). Patients were divided into two groups based on hospitalization duration: the first, "shorter hospitalization," included stays up to 11 days, whereas the second, "longer hospitalization," encompassed stays of 12 days and above. Results In total, 242 Caucasian patients, primarily women (172 women and 70 men), were recruited in the study. Patients with vitamin D deficiency had extended hospital stays compared with those with vitamin D levels below 49.92 nmol/L: 10.0 (8.00-13.00) days vs. 9.00 (8.00-11.00) days, P = 0.044. Hospitalization length (in days) had a negative correlation with vitamin D blood status (nmol/L) (P = 0.0005; R = -0.2243). ROC analysis indicated that patients with vitamin D levels below 31.2 nmol/L had a 47% higher chance of extended hospitalization, whereas those with levels above 31.2 nmol/L had a 77% higher chance of avoiding it. A significant majority of patients with suboptimal 25(OH)D levels experienced shorter hospital stays (≤11 days) than those with vitamin D deficiency (64.6%), P = 0.045. Conclusion The study findings indicate that lower serum levels of 25(OH)D in hospitalized patients within the geriatric department are linked to extended hospital stays. Vitamin D holds potential as a predictor of hospitalization duration in geriatric patients. Nonetheless, further research is imperative to account for additional factors affecting health status and hospitalization duration in older adults individuals.
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Affiliation(s)
- Justyna Nowak
- Department of Metabolic Disease Prevention, Faculty of Public Health in Bytom, Medical University of Silesia, Bytom, Poland
| | - Marzena Jabczyk
- Department of Metabolic Disease Prevention, Faculty of Public Health in Bytom, Medical University of Silesia, Bytom, Poland
| | - Paweł Jagielski
- Department of Nutrition and Drug Research, Faculty of Health Sciences, Institute of Public Health, Jagiellonian University Medical College, Krakow, Poland
| | - Bartosz Hudzik
- Department of Metabolic Disease Prevention, Faculty of Public Health in Bytom, Medical University of Silesia, Bytom, Poland
- Third Department of Cardiology, Silesian Center for Heart Disease, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Zabrze, Poland
| | - Katarzyna Brukało
- Department of Health Policy, Faculty of Public Health in Bytom, Medical University of Silesia, Bytom, Poland
| | - Jakub Borszcz
- Student Scientific Circle Affiliated of Department of Metabolic Disease Prevention, Faculty of Public Health in Bytom, Medical University of Silesia, Bytom, Poland
| | - Barbara Zubelewicz-Szkodzińska
- Department of Metabolic Disease Prevention, Faculty of Public Health in Bytom, Medical University of Silesia, Bytom, Poland
- Department of Endocrinology, District Hospital, Piekary Śląskie, Poland
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Płomiński J, Grzybowski R, Fiedorowicz E, Sienkiewicz-Szłapka E, Rozmus D, Król-Grzymała A, Jarmołowska B, Kordulewska N, Cieślińska A. Vitamin D Metabolic Pathway Components in Orthopedic Patientes-Systematic Review. Int J Mol Sci 2022; 23:ijms232415556. [PMID: 36555202 PMCID: PMC9779124 DOI: 10.3390/ijms232415556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 11/17/2022] [Accepted: 12/05/2022] [Indexed: 12/13/2022] Open
Abstract
Vitamin D takes part in the functioning of many processes that ensure the homeostasis of the body. In orthopedics, it is indicated as an inseparable element ensuring proper bone growth and functioning, and its deficiencies are indicated in various diseases, mainly in the proper structure and function of the skeleton. In this review, we focus on the most important components of the vitamin D metabolic pathway, in correlation with selected orthopedic conditions. Records were obtained from the PubMed database in a timeline of 2010-2022. The keywords were as follows: vitamin D/cholesterol/vitamin D binding protein/ VDBP/Cytochrome/CYP24A1/CYP 27B1/Vitamin D receptor/VDR/ + diseases (ACL reconstruction, rotator cuff, arthroplasty knee/hip/shoulder). The recent original studies were analyzed, discussed, and the most important data were shown. The vast majority of articles concern the metabolite of vitamin D (25(OH)D), which is measured as a standard in diagnostic laboratories. Even though there is a lot of valuable information in the literature, we believe that the other elements of the vitamin D pathway also deserve attention and suggest their research in correlation with orthopedic disorders to supplement the missing knowledge on this topic.
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Affiliation(s)
- Janusz Płomiński
- Clinical Department of Trauma—Orthopedic Surgery and Spine Surgery of the Provincial Specialist Hospital in Olsztyn, 10-561 Olsztyn, Poland
- Department and Clinic of Orthopedics and Traumatology, Collegium Medicum, University of Warmia and Mazury, 10-719 Olsztyn, Poland
| | - Roman Grzybowski
- Department and Clinic of Orthopedics and Traumatology, Collegium Medicum, University of Warmia and Mazury, 10-719 Olsztyn, Poland
| | - Ewa Fiedorowicz
- Faculty of Biology and Biotechnology, University of Warmia and Mazury, 10-719 Olsztyn, Poland
| | | | - Dominika Rozmus
- Faculty of Biology and Biotechnology, University of Warmia and Mazury, 10-719 Olsztyn, Poland
| | - Angelika Król-Grzymała
- Faculty of Biology and Biotechnology, University of Warmia and Mazury, 10-719 Olsztyn, Poland
| | - Beata Jarmołowska
- Faculty of Biology and Biotechnology, University of Warmia and Mazury, 10-719 Olsztyn, Poland
| | - Natalia Kordulewska
- Faculty of Biology and Biotechnology, University of Warmia and Mazury, 10-719 Olsztyn, Poland
| | - Anna Cieślińska
- Faculty of Biology and Biotechnology, University of Warmia and Mazury, 10-719 Olsztyn, Poland
- Correspondence:
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Vitamin D 3 Supplementation Prior to Total Knee Arthroplasty: A Randomized Controlled Trial. J Arthroplasty 2022; 38:S114-S119. [PMID: 35988825 DOI: 10.1016/j.arth.2022.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 08/10/2022] [Accepted: 08/11/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The purpose of this randomized controlled trial was to determine if a one-time dose of vitamin D3 prior to total knee arthroplasty improves function and patient-reported outcomes, while decreasing complications. METHODS One hundred seven patients undergoing primary total knee arthroplasty were randomized to receive 50,000 international units vitamin D3 (57 patients) or placebo (50 patients) on the morning of surgery. Power analysis determined 45 patients were required in each cohort to detect a minimal clinically important difference of 6 points in the functional component of the 2011 version of the Knee Society Score (KSS), assuming an alpha of 0.05 and power of 80%. KSS and a Timed Up and Go Test (TUGT) were measured preoperatively and at 3 and 6 weeks postoperatively. RESULTS There was no difference in improvement of KSS at 3 weeks (+4.8 points vitamin D3 versus +3.0 points placebo; P = .6) or 6 weeks (+14.5 points vitamin D3 versus +12.4 points placebo; P = .5) from baseline. There was no difference in change in TUGT at 3 weeks (+1.2 seconds vitamin D3 versus +0.6 seconds placebo; P = .6) or 6 weeks (-0.3 seconds vitamin D3 versus -0.9 seconds placebo; P = .6) from baseline. There were 4 complications in the placebo cohort within the first 90 days postoperatively and 5 complications in the vitamin D3 cohort (P = 1.0). CONCLUSION Supplementation with 50,000 international units vitamin D3 on the day of surgery failed to demonstrate statistical significant differences in functional KSS, TUGT times, or complications in the early postoperative period compared to placebo. LEVEL OF EVIDENCE Level I, therapeutic study.
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7
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Morrison RJM, Fishley WF, Rankin KS, Reed MR. The effect of vitamin D supplementation on outcomes following total hip or knee arthroplasty surgery: a rapid systematic review of current evidence. EFORT Open Rev 2022; 7:305-311. [PMID: 35510742 PMCID: PMC9142819 DOI: 10.1530/eor-21-0136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Purpose Vitamin D deficiency has been linked to poorer outcomes following hip (THR) and knee (TKR) replacement. We review the effect of peri-operative supplementation on clinical and patient-reported outcomes following THR/TKR. Methods This study was registered with PROSPERO (CRD42021238086). Searches of electronic databases were performed from inception to March 2021. All randomised, cohort, or case-controlled studies reported in English of adults undergoing THR/TKR where vitamin D supplementation was given peri-operatively and at least one outcome was reported were included. Studies reporting on vitamin D in relation to osteoporosis and hip fracture were excluded, as were conference abstracts and those involving preclinical models. Risks of bias were performed using the RoB-2 and ROBINS-I tools. Results Three studies comprising 413 TKR patients were identified; two were randomised controlled trials and one was a prospective cohort study. No studies meeting the inclusion criteria reported on the outcomes following THR. Supplementation was associated with a statistically significant reduction in the IL6:IL10 ratio at 24- and 48h following surgery, but no effect was noted on Western Ontario and McMaster Universities Osteoarthritis Index scores or the rates of falls. All studies were judged to be limited by bias, with heterogeneity in the supplementation dose and timing of administration, as well as the reported outcome measures used. Discussion Further adequately powered randomised-controlled trials using vitamin D supplementation and a specific clinically relevant or patient-reported outcome measure are required to assess if pre-operative vitamin D insufficiency is a modifiable risk factor to improve outcomes following THR/TKR.
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Affiliation(s)
- R J M Morrison
- Northumbria Healthcare NHS Foundation Trust, Ashington, UK
- Newcastle University, Newcastle upon Tyne, UK
| | - W F Fishley
- Northumbria Healthcare NHS Foundation Trust, Ashington, UK
- University of York, York, UK
| | - K S Rankin
- Newcastle University, Newcastle upon Tyne, UK
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - M R Reed
- Northumbria Healthcare NHS Foundation Trust, Ashington, UK
- University of York, York, UK
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Jeon YD, Cho SD, Youm YS, Song JY, Lee KJ, Park KB. The Prevalence of Vitamin D Deficiency in Patients Undergoing Total Knee Arthroplasty: A Propensity Score Matching Analysis. Arch Osteoporos 2022; 17:53. [PMID: 35320426 PMCID: PMC8942953 DOI: 10.1007/s11657-022-01097-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 03/15/2022] [Indexed: 02/03/2023]
Abstract
PURPOSE We investigated and compared the serum 25-OH vitamin D [25(OH)D] level and prevalence of vitamin D deficiency (VDD) between patients who underwent total knee arthroplasty (TKA) and healthy participants through a matched analysis. METHODS The unmatched case group consisted of 824 patients who underwent TKA and the unmatched control group 2,794 healthy participants examined at our institution. The control group was matched on the various characteristics-sex, age, weight, body mass index (BMI), blood chemistry, and season of sampling-through propensity score matching (PSM). After PSM, 501 and 721 patients were matched in the case and control group, respectively. Levels of blood chemistry including 25(OH)D were examined and VDD was defined as < 20 ng/mL. RESULTS The average serum 25(OH)D level was significantly lower in the OA group (15.3 ng/mL) than that in the control group (19.9 ng/mL, p < 0.001). When categorized using a 20 ng/mL cutoff, the VDD prevalence was 75.0% in the OA group and 59.4% in the control group. The prevalence of vitamin D insufficiency was 18.4% in the OA group and 24.5% in the control group. The prevalence of vitamin D sufficiency was 6.8% in the OA group and 15.9% in the control group (p < 0.001). CONCLUSIONS The patients who underwent TKA had lower serum 25(OH)D level and higher VDD prevalence compared to the healthy participants who matched using PSM. There were no differences in VDD rates by sex or obesity and the VDD prevalence was more than 70% during all season. Therefore, in patients undergoing TKA, general attention to VDD is required regardless of sex, obesity, and season. Serum 25-OH vitamin D [25(OH)D] level and vitamin D deficiency (VDD) prevalence were compared between patients undergoing total knee arthroplasty and healthy individuals. The differences in serum 25(OH)D level and VDD prevalence were significant between the two groups after propensity score matching.
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Affiliation(s)
- Young-Dae Jeon
- Department of Orthopaedic Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, 877 Bangeojinsunhwando-ro, Dong-gu, Ulsan, 44033, Republic of Korea
| | - Sung-Do Cho
- Department of Orthopaedic Surgery, Dongcheondongkang Hospital, Ulsan, Republic of Korea
| | - Yoon-Seok Youm
- Department of Orthopaedic Surgery, Dongguk University Ilsan Hospital, Goyang-si, Gyeonggi-do, Republic of Korea
| | - Joon-Yeon Song
- Department of Orthopaedic Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, 877 Bangeojinsunhwando-ro, Dong-gu, Ulsan, 44033, Republic of Korea
| | - Kyung-Joo Lee
- Department of Orthopaedic Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, 877 Bangeojinsunhwando-ro, Dong-gu, Ulsan, 44033, Republic of Korea
| | - Ki-Bong Park
- Department of Orthopaedic Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, 877 Bangeojinsunhwando-ro, Dong-gu, Ulsan, 44033, Republic of Korea.
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Chevalley T, Brandi ML, Cavalier E, Harvey NC, Iolascon G, Cooper C, Hannouche D, Kaux JF, Kurth A, Maggi S, Maier G, Papavasiliou K, Al-Daghri N, Sosa-Henríquez M, Suhm N, Tarantino U, Reginster JY, Rizzoli R. How can the orthopedic surgeon ensure optimal vitamin D status in patients operated for an osteoporotic fracture? Osteoporos Int 2021; 32:1921-1935. [PMID: 34013461 PMCID: PMC8134831 DOI: 10.1007/s00198-021-05957-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 04/09/2021] [Indexed: 12/19/2022]
Abstract
In this narrative review, the role of vitamin D deficiency in the pathophysiology, healing of fragility fractures, and rehabilitation is discussed. Vitamin D status can be assessed by measuring serum 25(OH)-vitamin D level with standardized assays. There is a high prevalence of vitamin D insufficiency (25(OH)D < 50 nmol/l (i.e., 20 ng/mL)) or deficiency (25(OH)D < 25 nmol/l (i.e., 10 ng/mL)) in patients with fragility fractures and especially in those with a hip fracture. The evidence on the effects of vitamin D deficiency and/or vitamin D supplementation on fracture healing and material osseointegration is still limited. However, it appears that vitamin D have a rather positive influence on these processes. The fracture liaison service (FLS) model can help to inform orthopedic surgeons, all caregivers, and fractured patients about the importance of optimal vitamin D status in the management of patients with fragility fractures. Therefore, vitamin D status should be included in Capture the Fracture® program as an outcome of FLS in addition to dual-energy X-ray absorptiometry (DXA) and specific antiosteoporosis medication. Vitamin D plays a significant role in the pathophysiology and healing of fragility fractures and in rehabilitation after fracture. Correction of vitamin D deficiency should be one of the main outcomes in fracture liaison services.
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Affiliation(s)
- T Chevalley
- Service of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.
| | - M L Brandi
- Metabolic Bone Diseases Unit, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - E Cavalier
- Department of Clinical Chemistry, University of Liege, CHU de Liege, Liege, Belgium
| | - N C Harvey
- MRC Lifecourse Epidemiology Unit, NIHR Southampton Biomedical Research Centre, University of Southampton, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - G Iolascon
- Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - C Cooper
- MRC Lifecourse Epidemiology Unit, NIHR Southampton Biomedical Research Centre, University of Southampton, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- UKNIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - D Hannouche
- Service of Orthopaedics and Trauma Surgery, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - J-F Kaux
- Department of Physical Medicine and Rehabilitation, University and University Hospital of Liège, Liège, Belgium
| | - A Kurth
- Department of Orthopaedic and Trauma Surgery, Campus Kemperhof, Community Clinics Middle Rhine, Koblenz, Germany
| | - S Maggi
- CNR Aging Branch-IN, Padua, Italy
| | - G Maier
- Department of Orthopaedic and Rheumatological Rehabilitation, Rehazentrum am Meer, Bad Zwischenahn, Germany
| | - K Papavasiliou
- 3rd Orthopaedic Department, Aristotle University of Thessaloniki Medical School, Papageorgiou General Hospital, Thessaloniki, Greece
| | - N Al-Daghri
- Chair for Biomarkers of Chronic Diseases, Biochemistry Department, College of Science King Saud University, Riyadh, 11451, Saudi Arabia
| | - M Sosa-Henríquez
- University Institute of Investigation on Biomedical Sciences (IUIBMS), University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Canary Islands, Spain
- Bone Metabolic Unit, Hospital University Insular, Las Palmas de Gran Canaria, Canary Islands, Spain
| | - N Suhm
- Department of Orthopaedic and Trauma Surgery, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland
| | - U Tarantino
- Department of Clinical Sciences and Translational Medicine, Faculty of Medicine and Surgery, Tor Vergata University of Rome, Via Montpellier 1, 00133, Rome, Italy
| | - J-Y Reginster
- Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
| | - R Rizzoli
- Service of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
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Maniar RN, Maniar AR, Jain D, Bhatnagar N, Gajjar A. Vitamin D Trajectory after Total Knee Arthroplasty: A Method for Quick Correction in Deficient Patients. Clin Orthop Surg 2021; 13:336-343. [PMID: 34484626 PMCID: PMC8380521 DOI: 10.4055/cios20147] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 06/24/2020] [Accepted: 09/02/2020] [Indexed: 12/21/2022] Open
Abstract
Backgroud It has been widely reported that vitamin D (vit D) affects preoperative, postoperative, and long-term outcomes after total knee arthroplasty (TKA). Our aim was to study vit D trajectory after TKA and compare effects of oral versus intramuscular (IM) supplementation in insufficient patients and assess its effects on immediate functional recovery in the first 2 weeks after TKA. Methods Vit D levels < 30 ng/mL are considered insufficient. We prospectively enrolled 60 patients (20 per group): group I, vit D sufficient patients; group II, vit D insufficient patients given IM supplementation (cholecalciferol 6,00,000 IU); and group III, vit D insufficient patients given oral supplementation (cholecalciferol 600,000 IU). Vit D levels, knee flexion, Timed Up and Go (TUG) test results, and visual analog scale (VAS) score were recorded preoperatively and postoperatively on day 3 and 14. Results In group I, mean preoperative vit D significantly dropped at postoperative day (POD) 3 and POD 14 (p = 0.001). In group II, mean preoperative vit D rose at POD 3 and rose significantly at POD 14 (p = 0.001). In group III, mean preoperative vit D increased significantly at both POD 3 and POD 14 (p < 0.001). Also, in group III, the rise in vit D was significantly higher than that in group II both at POD 3 and POD 14 (p < 0.05). In group III, 19 of 20 insufficient patients became sufficient on POD 3 and all 20 by POD 14. In group II, even by POD 14, only 11 of 20 insufficient patients became sufficient. Functional parameters (flexion, change in flexion, TUG test results, and VAS score) were comparable (p > 0.05) in all groups. Changes in TUG test showed a significant increase in group II (48.5 seconds) when compared to group I (35.5 seconds) at POD 3 (p < 0.05), suggesting a slower recovery. It remained comparable (p > 0.05) between group III and group I. Conclusions We found that vit D insufficient patients can be rapidly supplemented on the morning of surgery with a large dose of oral cholecalciferol 600,000 IU, and the effect was consistent over 2 weeks after surgery. Orally supplemented vit D insufficient patients also showed functional recovery comparable to vit D sufficient patients. IM supplementation increased vit D levels only at 2 weeks and the rise was significantly lower than oral supplementation. Interestingly, approximately 25% of vit D sufficient patients who were not supplemented after TKA became insufficient in the first 2 weeks postoperatively.
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Affiliation(s)
- Rajesh N Maniar
- Department of Orthopaedics, Lilavati Hospital and Research Centre, Mumbai, India.,Department of Orthopaedics, Breach Candy Hospital Trust, Mumbai, India
| | - Adit R Maniar
- Department of Orthopaedics, Lilavati Hospital and Research Centre, Mumbai, India.,Department of Orthopaedics, Breach Candy Hospital Trust, Mumbai, India
| | - Ditesh Jain
- Department of Orthopaedics, Lilavati Hospital and Research Centre, Mumbai, India
| | - Nishit Bhatnagar
- Department of Orthopaedics, Indraprastha Apollo Hospital, New Delhi, India
| | - Arpit Gajjar
- Department of Orthopaedics, Shanku Medicity, Gujarat, India
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11
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Maier GS, Weissenberger M, Rudert M, Roth KE, Horas K. The role of vitamin D and vitamin D deficiency in orthopaedics and traumatology-a narrative overview of the literature. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:942. [PMID: 34350257 PMCID: PMC8263860 DOI: 10.21037/atm-21-779] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 05/18/2021] [Indexed: 12/22/2022]
Abstract
Vitamin D is considered to play an important role in musculoskeletal health. It’s classical function is the regulation of calcium and phosphate homeostasis, thus ensuring a balanced bone metabolism that is characterised by an equal amount of bone resorption and bone formation. In the past decades, a plethora of pre-clinical and clinical studies reporting on potential health-beneficial properties of vitamin D have emerged. Moreover, there is an abundance of reports highlighting vitamin D deficiency and insufficiency in patients with almost innumerable diseases. Further, it is estimated that more than one billion people globally are affected by insufficient vitamin D levels. As such, research on vitamin D has been particularly popular over the past years. In orthopaedics and traumatology, most studies describe favourable effects of vitamin D in general. However, the relative importance of vitamin D is oftentimes debated. In this narrative review of the literature, we consider first, the properties of vitamin D and how vitamin D, vitamin D deficiency and the vitamin D receptor (VDR) impact on musculoskeletal health. Secondly, we provide an overview of studies reporting the prevalence of vitamin D deficiency in traumatology and diverse orthopaedic diseases including bone oncology. Lastly, we emphasise recent findings and touch on future perspectives in vitamin D research.
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Affiliation(s)
- Gerrit S Maier
- Rehazentrum am Meer, Bad Zwischenahn, Germany.,Department of Orthopaedic Surgery, Pius-Hospital, Carl-von-Ossietzky-University, Oldenburg, Germany
| | - Manuel Weissenberger
- Department of Orthopaedics, Koenig-Ludwig-Haus, Julius-Maximilians-University, Wuerzburg, Germany
| | - Maximilian Rudert
- Department of Orthopaedics, Koenig-Ludwig-Haus, Julius-Maximilians-University, Wuerzburg, Germany
| | - Klaus E Roth
- Department of Orthopaedic Surgery and Joint Academy, Gelenkzentrum Rhein-Main, Hochheim, Germany
| | - Konstantin Horas
- Department of Orthopaedics, Koenig-Ludwig-Haus, Julius-Maximilians-University, Wuerzburg, Germany.,Bernhard-Heine Centre for Musculoskeletal Research, University of Wuerzburg, Wuerzburg, Germany
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12
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Meyer M, Leiss F, Greimel F, Renkawitz T, Grifka J, Maderbacher G, Weber M. Impact of malnutrition and vitamin deficiency in geriatric patients undergoing orthopedic surgery. Acta Orthop 2021; 92:358-363. [PMID: 33538225 PMCID: PMC8231356 DOI: 10.1080/17453674.2021.1882092] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - There is growing evidence that hypoproteinemia is an important risk factor for adverse events after surgery. Less is known about the impact of vitamin deficiency on postoperative outcome. Therefore we evaluated the prevalence and impact of malnutrition and vitamin deficiency in geriatric patients undergoing elective orthopedic surgery.Patients and methods - In a retrospective analysis of 599 geriatric patients who had undergone elective orthopedic surgery in 2018 and 2019, hypoproteinemia, and deficiency of vitamin D, vitamin B12, and folate were assessed. Reoperation rates, readmission rates, complication rates, and transfusion rates were compared between malnourished patients and patients with normal parameters. Multivariable logistic regression models were used to assess the relationship between malnutrition and postoperative adverse events, controlling for confounding factors such as age, sex, diabetes mellitus, and frailty.Results - Patients with malnutrition showed a higher rate of reoperation (13% vs. 5.5%; p = 0.01) and exhibited more wound-healing disorders (7.4% vs. 1.3%, p = 0.001) as well as Clavien-Dindo IV° complications (7.4% vs. 2.4%; p = 0.03). Deficiency of vitamin D led to a higher rate of falls (8.4% vs. 2.9%, p = 0.006). Deficiency of vitamin B12 and folate did not affect postoperative adverse events. Although correlated to frailty (p = 0.004), multivariable regression analysis identified malnutrition as independent risk factor for reoperation (OR 2.6, 95% CI 1.1-6.2) and wound healing disorders (OR 7.1, CI 1.9-26).Interpretation - Malnutrition is common among geriatric patients undergoing elective orthopedic surgery and represents an independent risk factor for postoperative adverse events.
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Affiliation(s)
- Matthias Meyer
- Department of Orthopedic Surgery, Regensburg University Hospital, Bad Abbach; ,Correspondence:
| | - Franziska Leiss
- Department of Orthopedic Surgery, Regensburg University Hospital, Bad Abbach;
| | - Felix Greimel
- Department of Orthopedic Surgery, Regensburg University Hospital, Bad Abbach;
| | | | - Joachim Grifka
- Department of Orthopedic Surgery, Regensburg University Hospital, Bad Abbach;
| | - Günther Maderbacher
- Department of Orthopedic Surgery, Regensburg University Hospital, Bad Abbach;
| | - Markus Weber
- Department of Orthopedic Surgery, Regensburg University Hospital, Bad Abbach;
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Clements DN, Ryan JM, Handel IG, Gow AG, Campbell S, Hurst E, Mellanby RJ. Relationship between vitamin D status and clinical outcomes in dogs with a cranial cruciate ligament rupture. Res Vet Sci 2021; 136:385-389. [PMID: 33799168 DOI: 10.1016/j.rvsc.2021.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 10/07/2020] [Accepted: 03/23/2021] [Indexed: 11/16/2022]
Abstract
Cranial cruciate ligament rupture (CCLR) is one of the most common orthopaedic disorders diagnosed in dogs yet the factors which influence postoperative clinical outcomes are poorly understood. Low vitamin D status has been linked to poorer clinical outcomes in human patients undergoing elective orthopaedic surgery. The aim of this study was to examine the relationship between pre-operative vitamin D status, as defined by serum 25 hydroxyvitamin D (25(OH)D) concentrations, and initial disease severity and clinical outcomes in dogs undergoing surgical treatment for a CCLR. Serum 25(OH)D concentrations were measured in 44 dogs with a CCLR on the day before surgery. C-reactive protein concentrations were measured at a median time of 1 day post-surgery and the patient's clinical and radiographic response to CCLR surgical treatment was assessed at a median timepoint of 60 days post-surgery. Serum 25(OH)D concentrations in dogs with a CCLR was not significantly different to a population of healthy dogs (median 74.1 nmol/L and 88.40 nmol/L, respectively). There was no significant correlation between pre-operative serum 25(OH)D concentrations and length of pre-diagnosis clinical signs, pre-operative lameness scores or day 1 post-operative CRP concentrations. Thirty nine of the 44 dogs were re-examined at a median 60 days post-surgery. There was no relationship between the day 60 lameness scores and pre-operative serum 25(OH)D concentrations. In summary, we discovered that the vitamin D status of dogs with a CCLR was not significantly lower than healthy dogs and pre-operative serum 25(OH)D concentrations were not correlated to either pre-surgical disease severity or post-operative clinical outcomes.
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Affiliation(s)
- Dylan N Clements
- Royal (Dick) School of Veterinary Studies and The Roslin Institute, The University of Edinburgh, Hospital for Small Animals, Easter Bush Veterinary Centre, Roslin, Midlothian EH25 9RG, United Kingdom
| | - John M Ryan
- Royal (Dick) School of Veterinary Studies and The Roslin Institute, The University of Edinburgh, Hospital for Small Animals, Easter Bush Veterinary Centre, Roslin, Midlothian EH25 9RG, United Kingdom
| | - Ian G Handel
- Royal (Dick) School of Veterinary Studies and The Roslin Institute, The University of Edinburgh, Hospital for Small Animals, Easter Bush Veterinary Centre, Roslin, Midlothian EH25 9RG, United Kingdom
| | - Adam G Gow
- Royal (Dick) School of Veterinary Studies and The Roslin Institute, The University of Edinburgh, Hospital for Small Animals, Easter Bush Veterinary Centre, Roslin, Midlothian EH25 9RG, United Kingdom
| | - Susan Campbell
- Royal (Dick) School of Veterinary Studies and The Roslin Institute, The University of Edinburgh, Hospital for Small Animals, Easter Bush Veterinary Centre, Roslin, Midlothian EH25 9RG, United Kingdom
| | - Emma Hurst
- Royal (Dick) School of Veterinary Studies and The Roslin Institute, The University of Edinburgh, Hospital for Small Animals, Easter Bush Veterinary Centre, Roslin, Midlothian EH25 9RG, United Kingdom; Mass Spectrometry Core, Edinburgh Clinical Research Facility, Queen's Medical Research Institute, The University of Edinburgh, Little France Crescent, Edinburgh EH16 4TJ, Scotland, United Kingdom
| | - Richard J Mellanby
- Royal (Dick) School of Veterinary Studies and The Roslin Institute, The University of Edinburgh, Hospital for Small Animals, Easter Bush Veterinary Centre, Roslin, Midlothian EH25 9RG, United Kingdom.
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Briguglio M, Lombardi G, Sansoni V, Perego S, De Gennaro Colonna V, Stella D, Colombo C, Bonadies M, De Blasio G, Banfi G, Turiel M. Vitamin D, cardio-inflammation, and endothelial dysfunction in older adults after orthopedic surgery: Results from an open-label trial to ameliorate cardiac function. NUTR CLIN METAB 2020. [DOI: 10.1016/j.nupar.2020.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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15
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Ribbans WJ, Aujla R, Dalton S, Nunley JA. Vitamin D and the athlete-patient: state of the art. J ISAKOS 2020; 6:46-60. [PMID: 33833045 DOI: 10.1136/jisakos-2020-000435] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/20/2020] [Accepted: 07/28/2020] [Indexed: 11/04/2022]
Abstract
Vitamin D deficiency is common in athletes. The conventional measurement of vitamin D levels provides a general indicator of body stores. However, there are nuances in its interpretation as values of 25(OH)D do not correlate absolutely with the amount of 'bioavailable' vitamin to the cells. Vitamin D should be regarded as a hormone and influences between 5% and 10% of our total genome. Determining the precise effect of the vitamin, isolated from the actions of other cofactors, is not straightforward and restricts our complete understanding of all of its actions. Deficiency has harmful effects on not only bone and muscle but also wider areas, including immunity and respiratory and neurological activities. More caution should be applied regarding the ability of supranormal vitamin D levels to elevate athletic performance. Hopefully, future research will shed more light on optimal levels of vitamin D and supplementation regimes, and improved understanding of its intracellular control of our genetic mechanisms and how extrinsic influences modify its activity.
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Affiliation(s)
- William J Ribbans
- Faculty of Health, Education and Society, University of Northampton, Northampton, Northamptonshire, UK
| | - Randeep Aujla
- Perth Orthopaedic and Sports Medicine Centre, West Perth, Western Australia, Australia
| | - Seamus Dalton
- North Sydney Sports Medicine, Sydney, New South Wales, Australia
| | - James A Nunley
- Duke Orthopedics, Duke University, Durham, North Carolina, USA
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16
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Brambilla L, Peretti GM, Sirtori P, Maffulli N, Mangiavini L. Outcome of total hip and total knee arthroplasty and vitamin D homeostasis. Br Med Bull 2020; 135:50-61. [PMID: 32776138 DOI: 10.1093/bmb/ldaa018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 04/30/2020] [Accepted: 06/03/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Low levels of vitamin D are common in patients undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA), but it is still unclear whether the outcome of such surgery is related to vitamin D levels. SOURCES OF DATA Publicly available electronic databases were systematically reviewed to update knowledge about the role of vitamin D in THA and TKA patients, and to appraise the correlation between vitamin D levels before surgery and post-surgical outcomes. Eight studies were included in our review: six employed prospective observational designs, two reported retrospective database interrogations. Six prospective observational studies and two retrospective database interrogations matched inclusion and exclusion criteria. AREAS OF AGREEMENT Patients undergoing THA and TKA have a high prevalence of hypovitaminosis D. Five of eight studies (62.5%) report a statistically significant association between low vitamin D status and worse outcomes after THA and TKA. AREAS OF CONTROVERSY Different explanations have been proposed for vitamin D insufficiency, but some authors have questioned the correctness of the methods used to measure the vitamin D levels. GROWING POINTS A trial focusing on the role of vitamin D supplementation on safety and outcomes of patients undergoing THA and TKA with low vitamin D status is ongoing. AREAS TIMELY FOR DEVELOPING RESEARCH Further studies should explore the possible causal relationship between vitamin D status and outcomes of THA and TKA and verify the laboratory methods to analyse it.
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Affiliation(s)
- Lorenzo Brambilla
- Residency Program in Orthopaedics and Traumatology, University of Milan, Via Festa del Perdono, 7, 20122 Milan, Italy
| | - Giuseppe Maria Peretti
- University Equipe of Regenerative and Reconstructive Orthopaedics (EUORR), IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi, 4, 20161 Milan, Italy.,Department of Biomedical Sciences for Health, University of Milan, Via Festa del Perdono, 7, 20122 Milan, Italy
| | - Paolo Sirtori
- University Equipe of Regenerative and Reconstructive Orthopaedics (EUORR), IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi, 4, 20161 Milan, Italy
| | - Nicola Maffulli
- San Giovanni di Dio e Ruggi D'Aragona Hospital, "Clinica Ortopedica" Department, Hospital of Salerno, Via San Leonardo, 84125 Salerno, Italy.,School of Pharmacy and Bioengineering, Keele University Faculty of Medicine, Thornburrow Drive, Stoke on Trent ST4 7QB, UK.,Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, 275 Bancroft Road, London E1 4DG, UK
| | - Laura Mangiavini
- University Equipe of Regenerative and Reconstructive Orthopaedics (EUORR), IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi, 4, 20161 Milan, Italy.,Department of Biomedical Sciences for Health, University of Milan, Via Festa del Perdono, 7, 20122 Milan, Italy
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17
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Kenanidis E, Kakoulidis P, Karponis D, Tsiridis E. The Effect of Perioperative Vitamin D Levels on the Functional, Patient-Related Outcome Measures and the Risk of Infection Following Hip and Knee Arthroplasty: A Systematic Review. PATIENT-RELATED OUTCOME MEASURES 2020; 11:161-171. [PMID: 32982524 PMCID: PMC7490061 DOI: 10.2147/prom.s261251] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 07/31/2020] [Indexed: 12/30/2022]
Abstract
Introduction The aim of this study was to evaluate the effect of perioperative vitamin D levels in terms of functional results, patient-related outcome measures (PROMs) and infection risk after hip or knee replacement. Materials and Methods A systematic search in PubMed, Cochrane library, ScienceDirect and ClinicalTrials.gov was conducted according to the PRISMA guidelines from inception to January 2020. Results Eighteen studies with more than 8000 knee and 1500 hip joint arthroplasties were included. The mean follow-up ranged from 6 weeks to 1 year and mean patients’ age from 59.4 to 76 years. Hypovitaminosis was diagnosed in 26.7% of cases. Most studies did not find significant differences in pre- and postoperative functional results, PROMs and length of hospital stay between hypovitaminosis and euvitaminosis groups. Deficient patients may be at higher risk of postoperative joint stiffness. Patients suffering from hip and knee periprosthetic joint infection seem to have lower vitamin D levels compared to those with aseptic loosening of implants. Conclusion The necessity of pre-operative correction of vitamin D levels to achieve better functional results and minimize the risk of infection following hip and knee arthroplasty remains inconclusive. Extend of exposure to low vitamin D levels and comparison between outliers needs further evaluation.
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Affiliation(s)
- Eustathios Kenanidis
- Academic Orthopaedic Department, Papageorgiou General Hospital, Aristotle University Medical School, Thessaloniki, Greece.,Center of Orthopaedic and Regenerative Medicine - Center of Interdisciplinary Research and Innovation, Aristotle University Medical School, Thessaloniki, Greece
| | - Panagiotis Kakoulidis
- Academic Orthopaedic Department, Papageorgiou General Hospital, Aristotle University Medical School, Thessaloniki, Greece.,Center of Orthopaedic and Regenerative Medicine - Center of Interdisciplinary Research and Innovation, Aristotle University Medical School, Thessaloniki, Greece
| | - Dimitrios Karponis
- Oxford University Clinical Academic Graduate School, University of Oxford, Oxford, UK
| | - Eleftherios Tsiridis
- Academic Orthopaedic Department, Papageorgiou General Hospital, Aristotle University Medical School, Thessaloniki, Greece.,Center of Orthopaedic and Regenerative Medicine - Center of Interdisciplinary Research and Innovation, Aristotle University Medical School, Thessaloniki, Greece
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18
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Emara AK, Nageeb E, George J, Buttaro MA, Higuera C, Piuzzi NS. Hypovitaminosis D in lower extremity Joint Arthroplasty: A systematic review and meta-analysis. J Orthop 2020; 21:109-116. [PMID: 32255990 PMCID: PMC7114851 DOI: 10.1016/j.jor.2020.03.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 03/23/2020] [Indexed: 12/17/2022] Open
Abstract
The purpose of the current systematic review was to identify the prevalence of hypovitaminosis-D in LE-TJA patients; and outline the association between pre-operative hypovitaminosis and post-operative outcomes. A search of PubMed-Medline and the Cochrane-Library databases was performed for literature published before November 27th, 2019. The eighteen studies analyzed had a pooled prevalence for vitamin D insufficiency (20 - <30 ng/mL) and deficiency (<20 ng/mL) of 53.4% and 39.4%, respectively. Hypovitaminosis-D was associated with higher complication rates (p = 0.043), and a greater prevalence among septic versus aseptic revisions (p = 0.016). Therefore, pre-operative screening for hypovitaminosis-D can be beneficial in patients undergoing LE-TJA. LEVEL OF EVIDENCE Systematic Review (Level III).
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Affiliation(s)
- Ahmed K. Emara
- Cleveland Clinic, Department of Orthopedic Surgery, 9500 Euclid Ave/A41, Cleveland, OH, 44195, USA
| | - Emmanuel Nageeb
- Cleveland Clinic, Department of Orthopedic Surgery, 9500 Euclid Ave/A41, Cleveland, OH, 44195, USA
| | - Jaiben George
- Cleveland Clinic, Department of Orthopedic Surgery, 9500 Euclid Ave/A41, Cleveland, OH, 44195, USA
| | - Martin A. Buttaro
- Hip Surgery Unit "Sir John Charnley", Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Carlos Higuera
- Cleveland Clinic, Department of Orthopedic Surgery, 9500 Euclid Ave/A41, Cleveland, OH, 44195, USA
| | - Nicolas S. Piuzzi
- Cleveland Clinic, Department of Orthopedic Surgery, 9500 Euclid Ave/A41, Cleveland, OH, 44195, USA
- Instituto Universitario del Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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19
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Briguglio M, Gianola S, Aguirre MFI, Sirtori P, Perazzo P, Pennestri F, Brayda-Bruno M, Sansone V, Banfi G. Nutritional support for enhanced recovery programs in orthopedics: Future perspectives for implementing clinical practice. NUTR CLIN METAB 2019. [DOI: 10.1016/j.nupar.2019.04.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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21
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Vitamin D history part III: the "modern times"-new questions for orthopaedic practice: deficiency, cell therapy, osteomalacia, fractures, supplementation, infections. INTERNATIONAL ORTHOPAEDICS 2019; 43:1755-1771. [PMID: 31037319 DOI: 10.1007/s00264-019-04334-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Accepted: 04/08/2019] [Indexed: 12/18/2022]
Abstract
PURPOSE The nutritional basis for rickets was described between 1880 and 1915, at the same period of discovery of other "vital substances" or vitamins. In contrast, rickets could also be prevented or cured by sunshine. But as the capacity to produce vitamin D depends on exposure to ultraviolet B rays (UVB) from sunlight or artificial sources, vitamin D became one of the most frequently used "drugs" in the twentieth century to compensate for insufficient exposure to UVB of humans. Furthermore, as the understanding of vitamin D metabolism grew during the twentieth century, other concerns than rickets occurred for the orthopaedic surgeon: In recent history, deficiency is explored as being an associated factor of different bone pathologies as fracture or prosthetic infection. The aim of this review is to analyze these new data on vitamin D. MATERIALS AND METHODS During the twentieth century, there were many concerns for the orthopaedic surgeon: sources and synthesis of vitamin D, regulation of the calcium deposition process for both children and adults, when vitamin D deficiency is observed, and what the best method of vitamin D supplementation is. As target genes regulated by vitamin D are not limited to those involved in mineral homeostasis, orthopedists recently discovered that vitamin D might prevent periprosthetic infection. RESULTS The primary source (80%) of vitamin D is dermal synthesis related to the sun. Dietary sources (20%) of vitamin D are fat fishe, beef, liver, and eggs. Vitamin D is produced industrially to be used in fortified foods and supplements. Maintenance of skeletal calcium balance is mediated through vitamin D receptors. Progenitor cells, chondrocytes, osteoblasts, and osteoclasts contain these receptors which explains the role of vitamin D in cell therapy, in the prevention of rickets and osteomalacia. Despite fortified foods, the prevalence of deficiency remains endemic in north latitudes. However, the definition of vitamin D insufficiency or deficiency remains controversial. Vitamin D has been evaluated in patients undergoing fractures and elective orthopaedic procedures Although supplementation may not be able to prevent or cure all the orthopaedic pathologies, oral supplementation is able to improve the vitamin D levels of deficient patients. These vitamin D level improvements might be associated with better functional and clinical outcomes after some surgical procedures and improvement of immunity to decrease the risk of infection in arthroplasties. CONCLUSION Vitamin D deficiency is frequent and concerns millions of people in the world. It is therefore normal to find hypovitaminosis in various orthopaedic populations including trauma and arthroplasties. However, we do not know exactly if this phenomenon only reflects the general prevalence of vitamin D deficiency or has an influence on the outcome of some pathologies on specific populations at risk. After the success of treatment of rickets, it is disappointing that we are still wondering in the twenty-first century whether supplementation of a substance synthetized millions of years ago by plankton and necessary for growth of all the animals may improve (or not) clinical and functional outcomes of a simple fracture in humans.
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Moon AS, Boudreau S, Mussell E, He JK, Brabston EW, Ponce BA, Momaya AM. Current concepts in vitamin D and orthopaedic surgery. Orthop Traumatol Surg Res 2019; 105:375-382. [PMID: 30858042 DOI: 10.1016/j.otsr.2018.12.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 12/07/2018] [Accepted: 12/19/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Vitamin D plays an important role in the musculoskeletal system of the human body. Here, we review the most current literature on vitamin D as it relates to orthopaedic surgery and the musculoskeletal system, focusing largely on non-fracture applications. MATERIALS AND METHODS A literature review was performed on the basic science of vitamin D metabolism, epidemiology of vitamin D levels, role of vitamin D within the musculoskeletal system, and the correlation of vitamin D with injuries and orthopaedic surgical outcomes. RESULTS The existing literature suggests vitamin D plays multiple roles in the musculoskeletal system. Recent research has shed light on the importance of vitamin D in the setting of soft tissue healing and recovery in addition to affecting postoperative outcomes after common orthopaedic procedures. CONCLUSIONS Given the widespread prevalence of vitamin D deficiency, orthopaedic surgeons should be aware of the current evidence regarding clinical implications in patients with musculoskeletal complaints.
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Affiliation(s)
- Andrew S Moon
- Tufts University School of Medicine, Boston, MA, USA; Department of Orthopaedics, The University of Alabama at Birmingham, 951 18th St. S, 35205 Birmingham, AL, USA
| | - Sellers Boudreau
- Department of Orthopaedics, The University of Alabama at Birmingham, 951 18th St. S, 35205 Birmingham, AL, USA
| | - Eric Mussell
- Department of Orthopaedics, The University of Alabama at Birmingham, 951 18th St. S, 35205 Birmingham, AL, USA
| | - Jun Kit He
- Department of Orthopaedics, The University of Alabama at Birmingham, 951 18th St. S, 35205 Birmingham, AL, USA.
| | - Eugene W Brabston
- Department of Orthopaedics, The University of Alabama at Birmingham, 951 18th St. S, 35205 Birmingham, AL, USA
| | - Brent A Ponce
- Department of Orthopaedics, The University of Alabama at Birmingham, 951 18th St. S, 35205 Birmingham, AL, USA
| | - Amit M Momaya
- Department of Orthopaedics, The University of Alabama at Birmingham, 951 18th St. S, 35205 Birmingham, AL, USA
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Affiliation(s)
- Elaine Y Tran
- Division of Orthopaedic Surgery, Albany Medical College, Albany, New York
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Visser E, de Roos NM, Oosting E, Endenburg SC, Dronkers JJ. Association Between Preoperative Vitamin D Status and Short-Term Physical Performance after Total Hip Arthroplasty: A Prospective Study. ANNALS OF NUTRITION AND METABOLISM 2018; 73:252-260. [PMID: 30253382 DOI: 10.1159/000492938] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 08/16/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Insufficient serum vitamin D concentrations (50-75 nmol/L) are prevalent in 40-65% of patients who require total hip arthroplasty (THA). This could impair physical recovery after surgery. This study investigated the association between preoperative vitamin D status and physical performance after THA. Additionally, postoperative changes in vitamin D concentrations were measured. METHODS We included 87 patients scheduled for elective THA and aged ≥65 years. Three groups were recruited: patients classified as vitamin D deficient (< 50 nmol/L, n = 23), insufficient (50-75 nmol/L, n = 32), or sufficient (> 75 nmol/L, n = 32). Serum 25-hydroxyvitamin D3 (25[OH]D3) concentration and physical performance were measured perioperatively. Linear mixed models were used to examine differences between groups. RESULTS Change in physical performance over time was not affected by preoperative vitamin D status. In contrast, for physical activity, both vitamin D (p = 0.021) and time (p < 0.001) effect was seen: from 80.2 ± 25.8 to 58.1 ± 17.8 min/day in the deficient group, 143.7 ± 19.8 to 92.9 ± 11.5 min/day in the insufficient group, and 108.1 ± 20.9 to 62.3 ± 12.9 min/day in the sufficient group. The Chair Stand Test, Timed Up and Go test, and 10-Meter Walking Test also improved significantly over time, but independent of vitamin D status. An increase in 25(OH)D3 concentration 6 weeks postoperatively was correlated with improved hip function (Pearson's r = -0.471, p = 0.018). Overall, serum 25(OH)D3 declined with 32% one day after surgery (p < 0.001), to nearly return to baseline values 6 weeks later in all groups. CONCLUSION Vitamin D status did not appear to affect physical recovery after THA. The drop in vitamin D after surgery deserves further investigation, but could possibly be explained by hemodilution.
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Affiliation(s)
- Edith Visser
- Division of Human Nutrition, Wageningen University, Wageningen, the Netherlands
| | - Nicole M de Roos
- Division of Human Nutrition, Wageningen University, Wageningen, the Netherlands
| | - Ellen Oosting
- Department of Physical Therapy, Gelderse Vallei Hospital, Ede, the Netherlands
| | - Silvia C Endenburg
- Department of Clinical Chemistry and Hematology, Gelderse Vallei Hospital, Ede, the Netherlands
| | - Jaap J Dronkers
- Department of Physical Therapy, Gelderse Vallei Hospital, Ede, the Netherlands
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Hegde V, Arshi A, Wang C, Buser Z, Wang JC, Jensen AR, Adams JS, Zeegen EN, Bernthal NM. Preoperative Vitamin D Deficiency Is Associated With Higher Postoperative Complication Rates in Total Knee Arthroplasty. Orthopedics 2018; 41:e489-e495. [PMID: 29708568 DOI: 10.3928/01477447-20180424-04] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 02/05/2018] [Indexed: 02/03/2023]
Abstract
The purpose of this study was to determine the relative incidence of postoperative complications in 25-hydroxyvitamin D (25D)-deficient and -sufficient patients undergoing total knee arthroplasty (TKA). Patients who were either serum 25D deficient (25D <20 ng/mL) or 25D sufficient (25D ≥20 ng/mL) 90 days prior to primary TKA from 2007 to 2016 were identified using the Humana administrative claims registry. The incidence of postoperative medical and surgical complications was determined by querying for relevant International Classification of Diseases, Ninth Revision and Current Procedural Terminology codes. Risk-adjusted odds ratios (ORs) were calculated using multivariate logistic regression with age, sex, and Charlson Comorbidity Index as covariates. In total, 868 of 6593 patients who underwent TKA from 2007 to 2016 were 25D deficient, corresponding to a 13.2% prevalence rate. On adjustment for age, sex, and Charlson Comorbidity Index, 25D-deficient patients had a higher incidence of postoperative stiffness requiring manipulation under anesthesia (OR, 1.69; 95% confidence interval [CI], 1.39-2.04; P<.001), surgical site infection requiring irrigation and debridement (OR, 1.76; 95% CI, 1.25-2.48; P=.001), and prosthesis explantation (OR, 2.97; 95% CI, 2.04-4.31; P<.001) at 1 year. Patients who were 25D deficient also had higher rates of postoperative deep venous thrombosis (OR, 1.80; 95% CI, 1.36-2.38; P<.001), myocardial infarction (OR, 2.11; 95% CI, 1.41-3.15; P<.001), and cerebrovascular accident (OR, 1.73; 95% CI, 1.17-2.57; P=.006). Thus, serum 25D levels below 20 ng/mL are associated with a higher incidence of postoperative complications and may be a perioperative modifiable risk factor in TKA. [Orthopedics. 2018; 41(4):e489-e495.].
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Morrison RJM, Bunn D, Gray WK, Baker PN, White C, Rangan A, Rankin KS, Reed MR. VASO (Vitamin D and Arthroplasty Surgery Outcomes) study - supplementation of vitamin D deficiency to improve outcomes after total hip or knee replacement: study protocol for a randomised controlled feasibility trial. Trials 2017; 18:514. [PMID: 29096686 PMCID: PMC5669000 DOI: 10.1186/s13063-017-2255-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 10/11/2017] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Vitamin D deficiency has been linked to poor outcomes after total hip replacement (THR) or total knee replacement (TKR), including lower patient-reported outcome measures (PROMs), peri-prosthetic infection and longer hospital stay. We present a randomised feasibility trial protocol designed to prospectively investigate the influence of vitamin D testing, and subsequent supplementation for deficiency, prior to THR/TKR. METHODS/DESIGN One hundred adult patients undergoing primary THR/TKR for osteoarthritis at two NHS hospital trusts in North East England will be recruited. Exclusion criteria include lack of mental capacity, revision surgery, participants already taking vitamin D/calcium supplements, or a known contraindication to vitamin D treatment. Participants will be ineligible for the trial if they have an estimated glomerular filtration rate < 30 ml/minute. We will measure patients' vitamin D levels at baseline, and those identified as deficient (vitamin D < 50 nmol/L) will be randomised to receive either vitamin D supplementation or no supplementation prior to, and for 6 months following, surgery. Patients with a normal vitamin D level (≥50 nmol/L) will receive no supplementation. Vitamin D levels will be rechecked on the day of surgery and again at 6 months. Patients will also complete a lifestyle questionnaire, as well as the Oxford hip or knee and EQ-5D-3 L PROM questionnaires, at baseline and at 6 months following surgery. The aims are to determine the feasibility of the methodology and to gather data to inform the conduct of a future, larger trial to investigate if supplementation with vitamin D, in those who are deficient, prior to THR/TKR improves outcomes as measured by PROM scores. DISCUSSION Previous reports have measured vitamin D levels and correlated this to outcome, but we can find no randomised trial in which researchers investigated the effect of supplementation. The aim of this trial is to determine if vitamin D deficiency is a modifiable risk factor for poor outcome after THR/TKR. TRIAL REGISTRATION ISRCTN Registry, ISRCTN14533082 . Registered on 3 April 2017.
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Affiliation(s)
- Rory J M Morrison
- Department of Orthopaedics, Northumbria Healthcare NHS Foundation Trust, Woodhorn Lane, Ashington, Northumberland, NE63 9JJ, UK. .,University of Newcastle, Newcastle upon Tyne, NE1 7RU, UK.
| | - Deborah Bunn
- Research and Development, Northumbria Healthcare NHS Foundation Trust, Rake Lane, North Shields, NE29 8NH, UK
| | - William K Gray
- Research and Development, Northumbria Healthcare NHS Foundation Trust, Rake Lane, North Shields, NE29 8NH, UK
| | - Paul N Baker
- Department of Orthopaedics, South Tees Hospitals NHS Foundation Trust, Marton Lane, Middlesbrough, TS4 3BW, UK.,Department of Health Sciences, University of York, Heslington, York, YO10 5DD, UK
| | - Craig White
- Department of Orthopaedics, South Tees Hospitals NHS Foundation Trust, Marton Lane, Middlesbrough, TS4 3BW, UK
| | - Amar Rangan
- Department of Orthopaedics, South Tees Hospitals NHS Foundation Trust, Marton Lane, Middlesbrough, TS4 3BW, UK.,Department of Health Sciences, University of York, Heslington, York, YO10 5DD, UK.,Faculty of Medical Sciences & NDORMS, University of Oxford, Oxford, OX3 7LD, UK
| | | | - Mike R Reed
- Department of Orthopaedics, Northumbria Healthcare NHS Foundation Trust, Woodhorn Lane, Ashington, Northumberland, NE63 9JJ, UK.,University of Newcastle, Newcastle upon Tyne, NE1 7RU, UK.,Department of Health Sciences, University of York, Heslington, York, YO10 5DD, UK
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Schwartz FH, Lange J. Factors That Affect Outcome Following Total Joint Arthroplasty: a Review of the Recent Literature. Curr Rev Musculoskelet Med 2017; 10:346-355. [PMID: 28664450 DOI: 10.1007/s12178-017-9421-8] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE OF REVIEW It is well established that certain patient-specific risk factors affect outcomes following total joint arthroplasty. The goal of this paper is to summarize the latest data on several variables that have been investigated in the last 3 years and to characterize the effects these factors have on the success of hip and knee replacement. RECENT FINDINGS Preoperative diagnoses of depression and anxiety, liver disease, hypoalbuminemia, vitamin D deficiency, and diabetes mellitus are associated with increased risk of postoperative complications and can lead to worse outcomes after joint replacement surgery. Recent investigations have clearly established a link between these patient-specific factors and poor outcomes after hip and knee arthroplasty, but future research is needed to determine best practices for stratifying and mitigating these risks for patients.
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Affiliation(s)
- Forrest H Schwartz
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Jeffrey Lange
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
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Binkley N, Coursin D, Krueger D, Iglar P, Heiner J, Illgen R, Squire M, Lappe J, Watson P, Hogan K. Surgery alters parameters of vitamin D status and other laboratory results. Osteoporos Int 2017; 28:1013-1020. [PMID: 27826645 DOI: 10.1007/s00198-016-3819-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 10/24/2016] [Indexed: 12/12/2022]
Abstract
UNLABELLED Fracture liaison services often perform laboratory testing, but these results may be altered by surgery. In 40 hip arthroplasty patients, many laboratory parameters of bone health relevance were reduced by 8-22% on the first post-operative day. Laboratory results obtained in the immediate post-surgery interval do not reliably ascertain baseline status. INTRODUCTION As secondary causes of osteoporosis are common, fracture liaison services often perform laboratory testing in the immediate post-fracture interval. We hypothesized that laboratory results obtained shortly after surgery may not accurately ascertain baseline status. If true, such alterations might confound subsequent fracture prevention efforts. METHODS Patients undergoing elective total hip arthroplasty were studied as a surrogate for hip fracture patients. Blood and urine were obtained 2 weeks before surgery, before anesthetic induction, on post-operative day one, and 6 weeks after surgery. Serum total and free 25-hydroxyvitamin D (25(OH)D), vitamin D-binding protein (DBP), calcium, creatinine, albumin (Alb), alkaline phosphatase (ALP), plasma hemoglobin (Hgb) and urinary DBP/creatinine ratio (UDBP/Cr) were measured. RESULTS Forty volunteers (28 women; 12 men) with mean age of 65.7 [8.7] years were studied. Laboratory results were stable from 2 weeks before to the day of surgery. On the first day after surgery, total 25(OH)D, DBP, calcium, creatinine, ALP, and Alb declined 8-22% (p < 0.0001); free 25(OH)D and Hgb declined by 8 and 15% (p < 0.01), respectively; and UDBP/Cr increased 32% (p < 0.01). Using a 25(OH)D <30 ng/mL threshold, vitamin D inadequacy prevalence increased from 38% before surgery to 68% the day after (p < 0.001). All laboratory values returned to baseline at 6 weeks after surgery. CONCLUSIONS Laboratory values are reduced immediately following elective total hip arthroplasty. Testing at that time does not accurately ascertain baseline status and may lead to elevated estimates of vitamin D inadequacy, incorrect interventions, and misallocation of healthcare resources.
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Affiliation(s)
- N Binkley
- University of Wisconsin Osteoporosis Clinical Research Program, 2870 University Ave, Madison, WI, 53705, USA.
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
| | - D Coursin
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, B6/319 CSC, Madison, WI, 53792-3272, USA
| | - D Krueger
- University of Wisconsin Osteoporosis Clinical Research Program, 2870 University Ave, Madison, WI, 53705, USA
| | - P Iglar
- Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, 707 WARF Building, 610 North Walnut Street, Madison, WI, 53726, USA
| | - J Heiner
- Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health, 1685 Highland Avenue, Madison, WI, 53705-2281, USA
| | - R Illgen
- Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health, 1685 Highland Avenue, Madison, WI, 53705-2281, USA
| | - M Squire
- Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health, 1685 Highland Avenue, Madison, WI, 53705-2281, USA
| | - J Lappe
- Creighton University Osteoporosis Research Center, 601 N. 30th Street, Suite 4820, Omaha, NE, 68131, USA
| | - P Watson
- Creighton University Osteoporosis Research Center, 601 N. 30th Street, Suite 4820, Omaha, NE, 68131, USA
| | - K Hogan
- Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, B6/319 CSC, Madison, WI, 53792-3272, USA
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