Vitamin D Insufficiency in Patients With THA: Prevalence and Effects on Outcome

Abstract

Background The consequences of vitamin D insufficiency in the elderly remain controversial. The prevalence and potential effects of its chronic insufficiency on quality of life and physical function in patients undergoing THA have received little attention.Question/purposes We determined (1) prevalence of preoperative vitamin D insufficiency in patients undergoing THA and (2) relationships of insufficiency to patientperceived outcomes (PPOs) and hip scores. Methods We retrospectively reviewed 62 consecutive patients who underwent 66 primary THAs. We excluded two patients with missing data and the second hip of bilateral THAs, leaving 60 patients (60 hips) for final inclusion. Based on preoperative plasma 25-hydroxyvitamin-D3 levels, patients were retrospectively assigned into a normal or insufficient group. We used two different thresholds (20 and 30 ng/mL) to define insufficiency; groups were set twice. We compared demographics, BMI, American Society of Anesthesiologists score, Charlson Comorbidity Index; albumin, transferrin, calcium levels; and total lymphocyte count between groups. The insufficient group had a higher mean BMI with the 20-ng/mL cutoff but not with the 30-ng/mL cutoff. We compared the 20-ng/mL cutoff groups (adjusting for BMI) and the 30-ng/mL cutoff groups in terms of preoperative and postoperative Quality of Well-being Scale, SF-36, WOMAC, Harris hip, and Merle d'Aubigné-Postel scores. Mean followup was 11 months (range, 3-24 months). Results The prevalence of vitamin D insufficiency was 30% (using 20 ng/mL) and 65% (using 30 ng/mL). Preoperative and postoperative Harris hip and Merle d'Aubigné-Postel scores were lower in patients with

Association Between Preoperative Vitamin D Status and Short-Term Physical Performance after Total Hip Arthroplasty: A Prospective Study

“…Low vitamin D status was associated with a longer hospital stay in 1,083 German patients after either hip or knee arthroplasty [17]. Two other studies observed a positive association between serum 25(OH)D 3 concentrations and pre-and postoperative hip scores [15,18]. A study of 219 American THA patients had comparable measures as our study [14].…”

“…Other comparable studies mainly used questionnaires and disease-specific scores [15,18], but these are more prone to bias by socially desirable responses and misinterpretation.…”

“…According to the Clinical Practice Guidelines of the Endocrine Society, vitamin D sufficiency is defined as serum 25(OH)D 3 > 75 nmol/L and deficiency as serum 25(OH)D 3 < 50 nmol/L [13]. Previous studies showed that 40-65% of THA patients had vitamin D insufficiency, of which 8.5-30% were vitamin D deficient [4,14,15]. Among Dutch elderly (aged > 70 years), the prevalence of vitamin D insufficiency is 34.8% in men and 24.9% in women, whereas a vitamin D deficiency is present in 44.8% of men and in 60.1% of women [16].…”

“…Among Dutch elderly (aged > 70 years), the prevalence of vitamin D insufficiency is 34.8% in men and 24.9% in women, whereas a vitamin D deficiency is present in 44.8% of men and in 60.1% of women [16]. Previous studies showed that a low vitamin D status was correlated with poor postoperative hip scores, an increased length of hospital stay and increased risk of postoperative complications [15,[17][18][19]. However, preoperative vitamin D concentration was not associated to in-hospital functional milestones and postoperative functional status [4,14].…”

Factors That Affect Outcome Following Total Joint Arthroplasty: a Review of the Recent Literature

“…Some of the variables that have been shown to affect the outcome after total joint replacement include social and demographic characteristics, medical comorbidities, and surgical technique [3][4][5][6][7]. Areas of continued active research include the effect of intrinsic factors such as obesity [8][9][10], cardiovascular disease [11,12], mental health disorders [13•, 14-17•, 18•, 19], hepatic disease [20, 21•, 22, 23•, 24], nutritional deficiencies [25-29•, 30], bone metabolic disease [31][32][33][34][35][36][37], and diabetes mellitus [38•, 39, 40], as well as external factors such as nicotine use [41,42], recent corticosteroid injections [43][44][45][46][47], and discharge disposition [48,49]. The goal of this article is to review the most recent literature, published within the last 3 years, regarding a selection of patient-specific factors that may influence This article is part of the Topical Collection on Quality and Cost Control in TJA outcomes following total joint arthroplasty.…”