1
|
Horas K, Hoxha M, Heinz T, Jakuscheit A, List K, Maier GS, Weißenberger M, Rudert M. Prevalence and Risk Factors of Vitamin D Deficiency in Patients Scheduled to Undergo Revision Arthroplasty of the Hip, Knee and Shoulder-Data from a Single-Centre Analysis. Nutrients 2024; 16:3060. [PMID: 39339662 PMCID: PMC11434919 DOI: 10.3390/nu16183060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2024] [Revised: 09/06/2024] [Accepted: 09/09/2024] [Indexed: 09/30/2024] Open
Abstract
Vitamin D is crucial for ideal bone health and good muscle function, both essential requirements for successful joint arthroplasty. Hence, vitamin D deficiency has recently been identified as a predictor of poorer outcomes in patients scheduled to undergo total joint arthroplasty (TJA). Moreover, there is ample evidence today that vitamin D deficiency is associated with periprosthetic joint infection. Yet, vitamin D deficiency seems to be frequent in patients who are scheduled to undergo TJA. However, the prevalence of hypovitaminosis D in patients who require revision arthroplasty (rTJA) is largely unknown. Further, risk factors of vitamin D deficiency in these patients remain to be elucidated. For this reason, the primary objective of this study was to assess the vitamin D status of patients scheduled to undergo rTJA of the hip, knee and shoulder. The secondary objective was to identify potential risk factors for hypovitaminosis D in these patients. Serum vitamin D [25(OH)D] levels of 249 patients who were scheduled for rTJA were assessed over a period of twelve months at a high-volume TJA centre. Collectively, 23% of patients reported a routine intake of vitamin D supplements (58/249). Notably, 81% of patients (155/191) who did not report a routine vitamin D intake presented with insufficient vitamin D levels (below 30 ng/mL), while only 19% of patients (36/191) had sufficient vitamin D levels. Of those who reported a routine vitamin D intake, 75% (43/58) had sufficient vitamin D levels, while 25% (15/58) showed insufficient vitamin D status. Patients who did not routinely take any vitamin D supplements had significantly lower vitamin D levels compared to patients who reported regular vitamin D intake (19.91 ng/mL vs. 40.66 ng/mL). Further, BMI and nicotine abuse were identified as potential risk factors for hypovitaminosis D in patients without vitamin D supplementation. Moreover, the season of spring seems to be a risk factor in patients with vitamin D supplementation, while age itself did not appear to be a significant risk factor for low vitamin D levels. In conclusion, we found an alarmingly high rate of vitamin D deficiency in patients scheduled to undergo rTJA. Notably, reported routine vitamin D supplementation showed significantly increased serum vitamin D levels compared to patients with no reported supplementation. Due to the high prevalence of vitamin D deficiency, we believe that vitamin D status should routinely be assessed in patients who are scheduled to undergo rTJA.
Collapse
Affiliation(s)
- Konstantin Horas
- Orthopaedic Center for Musculoskeletal Research, University of Wuerzburg, 97074 Wuerzburg, Germany
- Frankfurt Centre for Bone Health and Endocrinology, 60313 Frankfurt, Germany
| | - Miledi Hoxha
- Orthopaedic Center for Musculoskeletal Research, University of Wuerzburg, 97074 Wuerzburg, Germany
| | - Tizian Heinz
- Department of Orthopaedic Surgery, Koenig-Ludwig-Haus, University of Wuerzburg, 97074 Wuerzburg, Germany
| | - Axel Jakuscheit
- Department of Orthopaedic Surgery, Koenig-Ludwig-Haus, University of Wuerzburg, 97074 Wuerzburg, Germany
| | - Kilian List
- Department of Orthopaedic Surgery, Koenig-Ludwig-Haus, University of Wuerzburg, 97074 Wuerzburg, Germany
| | - Gerrit S Maier
- Department of Orthopaedic Surgery, Pius-Hospital, Carl-von-Ossietzky-University, 26121 Oldenburg, Germany
| | - Manuel Weißenberger
- Orthopaedic Center for Musculoskeletal Research, University of Wuerzburg, 97074 Wuerzburg, Germany
- Orthopaedic Surgery Center, 97070 Wuerzburg, Germany
| | - Maximilian Rudert
- Orthopaedic Center for Musculoskeletal Research, University of Wuerzburg, 97074 Wuerzburg, Germany
- Department of Orthopaedic Surgery, Koenig-Ludwig-Haus, University of Wuerzburg, 97074 Wuerzburg, Germany
| |
Collapse
|
2
|
Karimijashni M, Ramsay T, Beaulé PE, Poitras S. Strategies to Manage Poorer Outcomes After Hip or Knee Arthroplasty: A Narrative Review of Current Understanding, Unanswered Questions, and Future Directions. Musculoskeletal Care 2024; 22:e1921. [PMID: 39075675 DOI: 10.1002/msc.1921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2024] [Accepted: 07/14/2024] [Indexed: 07/31/2024]
Abstract
PURPOSE Although hip or knee arthroplasty is generally a successful intervention, it is documented that 15%-30% of patients undergoing arthroplasty report suboptimal outcomes. This narrative review aims to provide an overview of the key findings concerning the management of poorer outcomes after hip or knee arthroplasty. METHOD A comprehensive search of articles was conducted up to November 2023 across three electronic databases. Only studies written in English were included, with no limitations applied regarding study design and time. RESULT Efficiently addressing poorer outcomes after arthroplasty necessitates a thorough exploration of appropriate methods for assessing recovery following hip or knee arthroplasty, ensuring accurate identification of patients at risk or experiencing poorer recovery. When selecting appropriate outcome measure tools, various factors should be taken into consideration, including understanding patients' priorities throughout the recovery process, assessing psychometric properties of outcome measure tools at different time points after arthroplasty, understanding how to combine/reconcile provider-assessed and patient-reported outcome measures, and determining the appropriate methods to interpret outcome measure scores. However, further research in these areas is warranted. In addition, the identification of key modifiable factors affecting outcomes and the development of interventions to manage these factors are needed. CONCLUSION There is growing attention paid to delivering interventions for patients at risk or not optimally recovering following hip or knee arthroplasty. To achieve this, it is essential to identify the most appropriate outcome measure tools, factors associated with poorer recovery and management of these factors.
Collapse
Affiliation(s)
- Motahareh Karimijashni
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Tim Ramsay
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Paul E Beaulé
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Stéphane Poitras
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
| |
Collapse
|
3
|
Rozmus D, Fiedorowicz E, Grzybowski R, Płomiński J, Cieślińska A. VDR Gene Polymorphisms ( BsmI, FokI, TaqI, ApaI) in Total Hip Arthroplasty Outcome Patients. Int J Mol Sci 2024; 25:8225. [PMID: 39125794 PMCID: PMC11311579 DOI: 10.3390/ijms25158225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Revised: 07/23/2024] [Accepted: 07/25/2024] [Indexed: 08/12/2024] Open
Abstract
A total hip arthroplasty (THA) can improve quality of life, but loosening of the hip prosthesis is a complex problem in which vitamin D may also play a role. The Vitamin D Receptor (VDR) is involved in the response of cells to the action of vitamin D, and its genetic variability raises the question of whether individual differences could influence the risk of prosthesis loosening. The aim of this study was to investigate the relationship between VDR single nucleotide polymorphisms (SNPs) (ApaI, BsmI, FokI and TaqI) and the serum VDR and 25(OH)D levels in three groups of patients: (1) arthroscopy patients after THA without loosening of the prosthesis (CA-Control Arthroplasty), (2) patients after THA with loosened hip prostheses (L-Loosening) and (3) the control group (C-Control). Our results suggest that the genotypes tt of TaqI, BB of BsmI, and FF of FokI may influence the VDR effect in patients with loosened protheses. Our results showed that the ACAC haplotype (AtBF) was over two times more frequent in the L group than in CA + C: OR =2.35 [95% CI 1.44-3.83; p = 0.001]. There was no significant correlation between the VDR and serum 25(OH)D levels, but there were differences between studied groups.
Collapse
Affiliation(s)
- Dominika Rozmus
- Department of Biochemistry, Faculty of Biology and Biotechnology, University of Warmia and Mazury in Olsztyn, 1A Oczapowskiego Street, 10-719 Olsztyn, Poland; (D.R.); (E.F.)
| | - Ewa Fiedorowicz
- Department of Biochemistry, Faculty of Biology and Biotechnology, University of Warmia and Mazury in Olsztyn, 1A Oczapowskiego Street, 10-719 Olsztyn, Poland; (D.R.); (E.F.)
| | - Roman Grzybowski
- Department of Orthopedics and Traumatology, Collegium Medicum, University of Warmia and Mazury in Olsztyn, Aleja Warszawska 30, 11-041 Olsztyn, Poland;
| | - Janusz Płomiński
- Department of Orthopedics, Centre of Postgraduate Medical Education, Gruca Orthopaedic and Trauma Teaching Hospital, Konarskiego 13, 05-400 Otwock, Poland;
| | - Anna Cieślińska
- Department of Biochemistry, Faculty of Biology and Biotechnology, University of Warmia and Mazury in Olsztyn, 1A Oczapowskiego Street, 10-719 Olsztyn, Poland; (D.R.); (E.F.)
| |
Collapse
|
4
|
Liu C, Seyok T, Moye S, Sugita L, Eltouny E, Carrera C, Denagamage P, Charles J, Fitz W, Chen AF, Earp B. High rates of vitamin D insufficiency among patients presenting for total knee arthroplasty. J Orthop Res 2024. [PMID: 38414362 DOI: 10.1002/jor.25811] [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: 03/03/2023] [Revised: 10/20/2023] [Accepted: 01/19/2024] [Indexed: 02/29/2024]
Abstract
Widely varying prevalence of vitamin D deficiency has been reported in patients presenting for total knee arthroplasty (TKA). The primary aim of this study was to determine vitamin D levels in TKA patients and to compare to patients already routinely evaluated for vitamin D levels, patients with fragility fractures of the distal radius (DRF). There is significant overlap between patients presenting for TKA and with DRF, both in terms of medical comorbidities and overall health status, making these populations suitable comparative cohorts. Wefound that all patients presenting for TKA consultation had vitamin D insufficiency and 33% had vitamin D deficiency, compared to only 37% and 14% in the DRF cohort, a patient population routinely evaluated for vitamin D due to the high risk of deficiency. Furthermore, patients with DRF had higher levels of vitamin D before (38 ± 16 vs. 23 ± 5) and after vitamin D supplementation (39 ± 17 vs. 33 ± 10), suggesting that patients presenting for TKA are at even higher risk of vitamin D insufficiency than patients presenting with DRF. Reassuringly, supplementation successfully corrected 39.0% and 55.8% of patients in the DRF and TKA cohorts, respectively.
Collapse
Affiliation(s)
- Christina Liu
- Division of Hand and Upper Extremity Surgery, Department of Orthopedics, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Division of Arthroplasty, Department of Orthopedics, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Thany Seyok
- Division of Hand and Upper Extremity Surgery, Department of Orthopedics, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Stephen Moye
- Harvard Medical School, Boston, Massachusetts, USA
| | | | - Ehab Eltouny
- Division of Arthroplasty, Department of Orthopedics, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Christopher Carrera
- Division of Arthroplasty, Department of Orthopedics, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Prabhavi Denagamage
- Division of Arthroplasty, Department of Orthopedics, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Julia Charles
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Rheumatology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Wolfgang Fitz
- Division of Arthroplasty, Department of Orthopedics, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Antonia F Chen
- Division of Arthroplasty, Department of Orthopedics, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Brandon Earp
- Division of Hand and Upper Extremity Surgery, Department of Orthopedics, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
5
|
Lachance AD, Call C, Radford Z, Stoddard H, Sturgeon C, Babikian G, Rana A, McGrory BJ. The Association of Season of Surgery and Patient Reported Outcomes following Total Hip Arthroplasty. Geriatr Orthop Surg Rehabil 2024; 15:21514593241227805. [PMID: 38221927 PMCID: PMC10787533 DOI: 10.1177/21514593241227805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 11/13/2023] [Accepted: 01/05/2023] [Indexed: 01/16/2024] Open
Abstract
Background Understanding the impact of situational variables on surgical recovery can improve outcomes in total hip arthroplasty (THA). Literature examining hospital outcomes by season remains inconclusive, with limited focus on patient experience. The aim of this study is to investigate if there are differences in hospital and patient-reported outcomes measures (PROMS) after THA depending on the season of the index procedure to improve surgeon preoperative counseling. Methods A retrospective chart review was performed on patients undergoing primary THA at a single large academic center between January 2013 and August 2020. Demographic, operative, hospital, and PROMs were gathered from the institutional electronic medical record and our institutional joint replacement outcomes database. Results 6418 patients underwent primary THA and met inclusion criteria. Of this patient population, 1636 underwent surgery in winter, 1543 in spring, 1811 in summer, and 1428 in fall. PROMs were equivalent across seasons at nearly time points. The average age of patients was 65 (+/- 10) years, with an average BMI of 29.3 (+/- 6). Rates of complications including ED visits within 30 days, readmission within 90 days, unplanned readmission, dislocation, fracture, or wound infection were not significantly different by season (P > .05). Conclusion Our findings indicate no differences in complications and PROMs at 1 year in patients undergoing THA during 4 distinct seasons. Notably, patients had functional differences at the second follow-up visit, suggesting variation in short-term recovery. Patients could be counseled that they have similar rates of complications and postoperative recovery regardless of season.
Collapse
Affiliation(s)
| | | | - Zachary Radford
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, USA
| | - Henry Stoddard
- Maine Health Institute for Research, Scarborough, ME, USA
| | | | | | - Adam Rana
- Maine Medical Center, Portland, ME, USA
- Tufts University School of Medicine, Maine Medical Center, Portland, ME, USA
| | - Brian J. McGrory
- Maine Medical Center, Portland, ME, USA
- Tufts University School of Medicine, Maine Medical Center, Portland, ME, USA
| |
Collapse
|
6
|
Piuzzi NS, Klika AK, Lu Q, Higuera-Rueda CA, Stappenbeck T, Visperas A. Periprosthetic joint infection and immunity: Current understanding of host-microbe interplay. J Orthop Res 2024; 42:7-20. [PMID: 37874328 DOI: 10.1002/jor.25723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 09/19/2023] [Accepted: 10/17/2023] [Indexed: 10/25/2023]
Abstract
Periprosthetic joint infection (PJI) is a major complication of total joint arthroplasty. Even with current treatments, failure rates are unacceptably high with a 5-year mortality rate of 26%. Majority of the literature in the field has focused on development of better biomarkers for diagnostics and treatment strategies including innovate antibiotic delivery systems, antibiofilm agents, and bacteriophages. Nevertheless, the role of the immune system, our first line of defense during PJI, is not well understood. Evidence of infection in PJI patients is found within circulation, synovial fluid, and tissue and include numerous cytokines, metabolites, antimicrobial peptides, and soluble receptors that are part of the PJI diagnosis workup. Macrophages, neutrophils, and myeloid-derived suppressor cells (MDSCs) are initially recruited into the joint by chemokines and cytokines produced by immune cells and bacteria and are activated by pathogen-associated molecular patterns. While these cells are efficient killers of planktonic bacteria by phagocytosis, opsonization, degranulation, and recruitment of adaptive immune cells, biofilm-associated bacteria are troublesome. Biofilm is not only a physical barrier for the immune system but also elicits effector functions. Additionally, bacteria have developed mechanisms to evade the immune system by inactivating effector molecules, promoting killing or anti-inflammatory effector cell phenotypes, and intracellular persistence and dissemination. Understanding these shortcomings and the mechanisms by which bacteria can subvert the immune system may open new approaches to better prepare our own immune system to combat PJI. Furthermore, preoperative immune system assessment and screening for dysregulation may aid in developing preventative interventions to decrease PJI incidence.
Collapse
Affiliation(s)
- Nicolas S Piuzzi
- Department of Orthopaedic Surgery, Cleveland Clinic Adult Reconstruction Research (CCARR), Cleveland Clinic, Cleveland, Ohio, USA
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, Ohio, USA
| | - Alison K Klika
- Department of Orthopaedic Surgery, Cleveland Clinic Adult Reconstruction Research (CCARR), Cleveland Clinic, Cleveland, Ohio, USA
| | - Qiuhe Lu
- Department of Inflammation and Immunity, Cleveland Clinic, Cleveland, Ohio, USA
| | | | | | - Anabelle Visperas
- Department of Orthopaedic Surgery, Cleveland Clinic Adult Reconstruction Research (CCARR), Cleveland Clinic, Cleveland, Ohio, USA
| |
Collapse
|
7
|
Rakutt MJ, Eason TB, Boyle KK, Buller LT, Krueger CA, Jacobs CA, Duncan ST, Landy DC. Nutritional Laboratory Studies Prior to Total Knee Arthroplasty: Practice Versus Publication. J Bone Joint Surg Am 2023; 105:1947-1953. [PMID: 37769038 DOI: 10.2106/jbjs.23.00572] [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: 09/30/2023]
Abstract
BACKGROUND Recent emphasis has been placed on nutritional status assessment prior to total knee arthroplasty (TKA), including multiple American Academy of Orthopaedic Surgeons publications recommending specific laboratory studies; however, the frequency with which surgeons obtain these laboratory studies remains unclear. We sought to assess the incidence of ordering nutritional laboratory studies in the 90 days prior to TKA, utilizing data from a large administrative claims database. METHODS With use of the PearlDiver database, we identified 557,670 patients undergoing primary TKA from 2011 to 2020 with a metabolic panel or blood cell count claim within 90 days prior to TKA. We then determined the incidence of prealbumin, transferrin, vitamin D, and zinc laboratory tests claimed 90 days prior to TKA. Associations between claims and the year of surgery, patient demographics, and clinical characteristics were assessed by comparing proportions and chi-square testing. RESULTS Nutritional laboratory studies were infrequently claimed within 90 days prior to TKA, with studies for prealbumin being performed in 2.2% of patients; transferrin, 1.9%; vitamin D, 10.2%; and zinc, 0.2%. From 2011 to 2020, there was a moderate but steady increase in the proportion of patients with claims for prealbumin (change from 0.8% in 2011 to 3.4% in 2020; p < 0.001), transferrin (0.8% to 2.7%; p < 0.001), and vitamin D (7.6% to 9.4%; p < 0.001) laboratory tests but there was less of a change for zinc (0.1% to 0.2%; p < 0.001). There were weak-to-absent associations of age, gender, obesity, diabetes, and anemia with laboratory claims. CONCLUSIONS Despite multiple publications and recommendations, nutritional laboratory studies are infrequently ordered prior to TKA. Although there has been a slight increase in the use of nutritional laboratory studies over the past decade, patient factors such as gender and obesity were not associated with this increase. Understanding current practice patterns may help target future areas for improvement. LEVEL OF EVIDENCE Diagnostic Level III . See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Maxwell J Rakutt
- Department of Orthopaedic Surgery, University of Vermont, Burlington, Vermont
| | - Travis B Eason
- Department of Orthopaedic Surgery, University of Kentucky, Lexington, Kentucky
| | - K Keely Boyle
- Department of Orthopaedic Surgery, University of Buffalo School of Medicine, Buffalo, New York
| | - Leonard T Buller
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Philadelphia, Pennsylvania
| | - Chad A Krueger
- Department of Orthopedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Cale A Jacobs
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Stephen T Duncan
- Department of Orthopaedic Surgery, University of Kentucky, Lexington, Kentucky
| | - David C Landy
- Department of Orthopaedic Surgery, University of Kentucky, Lexington, Kentucky
| |
Collapse
|
8
|
Phillips JLH, Ennis HE, Jennings JM, Dennis DA. Screening and Management of Malnutrition in Total Joint Arthroplasty. J Am Acad Orthop Surg 2023; 31:319-325. [PMID: 36812414 DOI: 10.5435/jaaos-d-22-01035] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 01/19/2023] [Indexed: 02/24/2023] Open
Abstract
Malnutrition is an increasingly prevalent problem in patients undergoing total joint arthroplasty (TJA). Increased risks associated with TJA in the setting of malnourishment have been well documented. Standardized scoring systems in addition to laboratory parameters such as albumin, prealbumin, transferrin, and total lymphocyte count have been developed to identify and evaluate malnourished patients. Despite an abundance of recent literature, there is no consensus on the best approach for screening TJA patients from a nutritional standpoint. Although there are a variety of treatment options, including nutritional supplements, nonsurgical weight loss therapies, bariatric surgery, and the involvement of dieticians and nutritionists, the effect of these interventions on TJA outcomes has not been well characterized. This overview of the most current literature aims to provide a clinical framework for approaching nutrition status in arthroplasty patients. A comprehensive understanding of the tools available for managing malnourishment will facilitate improved arthroplasty care.
Collapse
Affiliation(s)
- Jessica L H Phillips
- From the Colorado Joint Replacement (Phillips, Ennis, Jennings, and Dennis), the Department of Mechanical and Materials Engineering, University of Denver (Jennings and Dennis), the Department of Orthopaedics, University of Colorado School of Medicine (Dennis), Denver, CO, and the Department of Biomedical Engineering, University of Tennessee, Knoxville, TN (Dennis)
| | | | | | | |
Collapse
|
9
|
Ametejani M, Masoudi N, Homapour F, Rezaei S, Moosavi SA, Kafili E, Heidarlou AJ. Association between Pre-Operative 25-Hydroxy Vitamin D Deficiency and Surgical Site Infection after Right Hemicolectomy Surgery. Surg Infect (Larchmt) 2022; 23:829-833. [PMID: 36219723 DOI: 10.1089/sur.2022.122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Surgical site infection (SSI) is one of the most important and costly complications of surgical operations. The present study hypothesized that vitamin D deficiency is associated with an increased risk of SSI, and this current study investigated this hypothesis. Patients and Methods: A prospective cohort study was performed with adult patients undergoing open right hemicolectomy operation with stapled anastomosis between February 2018 and March 2021 in the surgery ward of Imam Khomeini hospital. A logistic regression test examined and analyzed the connection between serum 25-OH vitamin D levels and post-operative wound infections. Results: This study comprised 315 participants who met the inclusion criteria. Pre-operative serum vitamin D levels were <30 ng/mL in 107 participants (34%) and ≥30 ng/mL in 208 participants (66%). The mean serum vitamin D level was 35.66 ± 13.26 ng/mL among the study population. Increased vitamin D deficiency was linked with elevated odds of surgical wound infection incidence among the patients after surgery (odds ratio [OR], 5.49; 95% confidence interval [CI], 2.06-14.6; p = 0.001). Conclusions: Pre-operative vitamin D level strongly affects post-operative SSI in patients with colon cancer. This study highlighted the importance of conducting further research to determine the possible advantages of vitamin D in preventing incision infection after surgery.
Collapse
Affiliation(s)
- Morteza Ametejani
- Department of General Surgery, School of Medicine, University of Medical Sciences, Urmia, Iran
| | - Naser Masoudi
- Department of General Surgery, School of Medicine, University of Medical Sciences, Urmia, Iran
| | - Farhad Homapour
- Department of General Surgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Seifollah Rezaei
- Department of General Surgery, School of Medicine, University of Medical Sciences, Urmia, Iran
| | - Seyed Amin Moosavi
- Department of General Surgery, School of Medicine, University of Medical Sciences, Urmia, Iran
| | - Ehsan Kafili
- Department of General Surgery, School of Medicine, University of Medical Sciences, Urmia, Iran
| | - Ali Jafari Heidarlou
- Department of General Surgery, School of Medicine, University of Medical Sciences, Urmia, Iran
| |
Collapse
|
10
|
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.
Collapse
|
11
|
Meyer M, Grifka J, Kappenschneider T. [Preoperative screening for risk factors]. ORTHOPADIE (HEIDELBERG, GERMANY) 2022; 51:684-692. [PMID: 35925284 DOI: 10.1007/s00132-022-04258-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/14/2022] [Indexed: 06/15/2023]
Abstract
The demographic change and continuously improving healthcare lead to increasing numbers of older, comorbid patients in elective orthopedic surgery. Perioperative risk assessment is crucial for patient counseling and preoperative planning. Risk factors, such as heart failure, chronic obstructive pulmonary disease, peripheral arterial occlusive disease, anemia, malnutrition, obesity, smoking and insufficiently controlled diabetes mellitus are common in patients undergoing elective orthopedic surgery. A thorough and early screening not only enables the individual assessment of the risk profile but in an elective setting also enables the chance for modification of certain risk factors in order to reduce the individual perioperative risk. Meanwhile, recommendations regarding risk stratification and adjustment of modifiable risk factors are included in national guidelines on the indications for elective total hip arthroplasty.
Collapse
Affiliation(s)
- Matthias Meyer
- Orthopädische Klinik für die Universität Regensburg im Asklepios Klinikum, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Deutschland.
| | - Joachim Grifka
- Orthopädische Klinik für die Universität Regensburg im Asklepios Klinikum, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Deutschland
| | - Tobias Kappenschneider
- Orthopädische Klinik für die Universität Regensburg im Asklepios Klinikum, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Deutschland
| |
Collapse
|
12
|
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.
Collapse
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
| |
Collapse
|
13
|
Meyer M, Kappenschneider T, Grifka J, Weber M. [Risk management in orthopedic surgery : Stratification and adjustment of patient-individual risk factors]. DER ORTHOPADE 2022; 51:81-90. [PMID: 34997246 DOI: 10.1007/s00132-021-04206-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/15/2021] [Indexed: 10/19/2022]
Abstract
Preoperative identification of patients at risk of postoperative complications enables better patient education and surgical planning for the orthopedic surgeon. In addition to demographic and intervention-specific factors, a variety of instruments are available for individual risk assessment. The concept of frailty seems to be promising to identify patients at risk. Modifiable risk factors such as malnutrition, anemia, obesity, smoking, and insufficiently controlled diabetes mellitus are common in elective orthopedic patients. With the use of screening protocols, modifiable risk factors can be identified and optimized preoperatively in order to reduce the individual risk of complications. Recommendations regarding preoperative risk stratification and modification prior to elective hip replacement have meanwhile been incorporated in national guidelines.
Collapse
Affiliation(s)
- Matthias Meyer
- Orthopädische Klinik für die Universität Regensburg, Regensburg, Deutschland. .,Orthopädische Klinik für die Universität Regensburg, Asklepios Klinikum, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Deutschland.
| | - Tobias Kappenschneider
- Orthopädische Klinik für die Universität Regensburg, Asklepios Klinikum, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Deutschland
| | - Joachim Grifka
- Orthopädische Klinik für die Universität Regensburg, Asklepios Klinikum, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Deutschland
| | - Markus Weber
- Klinik für Unfallchirurgie, Orthopädie und Sportmedizin, Krankenhaus Barmherzige Brüder Regensburg, Regensburg, Deutschland
| |
Collapse
|
14
|
Liu C, Brinkmann E, Chou SH, Tejada Arias K, Cooper L, Javedan H, Iorio R, Chen AF. Team Approach: Preoperative Management of Metabolic Conditions in Total Joint Replacement. JBJS Rev 2021; 9:01874474-202112000-00003. [PMID: 34910700 DOI: 10.2106/jbjs.rvw.21.00112] [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: 11/14/2022]
Abstract
» Total joint arthroplasties (TJAs) of the knee and hip have been considered 2 of the most successful surgical procedures performed to date. » Frailty is defined as increased vulnerability to adverse outcomes with physiologic stress. » Preoperative optimization of frailty and metabolic bone conditions, including osteoporosis, vitamin D deficiency, and diabetes, through a multidisciplinary approach can help improve outcomes and minimize costs after TJA.
Collapse
Affiliation(s)
- Christina Liu
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Elyse Brinkmann
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Sharon H Chou
- Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Karla Tejada Arias
- Harvard Medical School, Boston, Massachusetts
- Division of Aging, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Lisa Cooper
- Harvard Medical School, Boston, Massachusetts
- Division of Aging, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Houman Javedan
- Division of Aging, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Richard Iorio
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Antonia F Chen
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
15
|
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.
Collapse
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
| |
Collapse
|