Does vitamin D deficiency / insufficiency lead to worse outcomes in Total Joint Arthroplasty?
There is a growing body of literature on vitamin D supplementation and it is becoming increasingly common and accepted due to its health benefits. AAOS experts have recognized its impact in protecting bone and joint health.*
In this context, a group of international orthopedic surgeons investigated the association between hypovitaminosis D and TJA outcomes. The teams of Carlos Higuera MD (Cleveland Clinic, Ohio, USA) and Martin Buttaro MD (Buenos Aires, Argentina) reviewed a total of 18 studies (9895 patients), including both primary and revision TJA and published their findings (Level III study).
In the studies that analysed vitamin D insufficiency, serum levels 20 - < 30 ng/mL, the pooled prevalence using a random effects model was 53.4%. In studies which reported vitamin D insufficiency, serum levels < 20 ng/mL, the pooled prevalence using a random-effects model was 39.4%.
Results
➡ The findings suggest higher rates of complications (e.g. periprosthetic joint infection, post operative-cognitive dysfunction) in patients with hypovitaminosis-D
➡ Additionally, five of nine studies indicated a sufficient vitamin D level was associated with superior patient reported outcomes. However, pooled analyses failed to demonstrate a statistically significant difference in WOMAC scores.
The evidence surrounding vitamin D supplementation in orthopedic health is still not conclusive but continues to grow. Reason enough for the authors to conclude that pre-operative screening for hypovitaminosis-D could be beneficial in patients undergoing hip or knee replacement as it could mitigate post-operative complications.
📚 Reference: 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. Published 2020 Mar 25. doi:10.1016/j.jor.2020.03.010