Association Between Preoperative Vitamin D Status and Short-Term Physical Performance after Total Hip Arthroplasty: A Prospective Study.
Ann Nutr Metab. 2018 Sep 25;73(3):252-260. doi: 10.1159/000492938. [Epub ahead of print]
Visser E1, de Roos NM1, Oosting E2, Endenburg SC3, Dronkers JJ2.
1 Division of Human Nutrition, Wageningen University, Wageningen, the Netherlands.
2 Department of Physical Therapy, Gelderse Vallei Hospital, Ede, the Netherlands.
3 Department of Clinical Chemistry and Hematology, Gelderse Vallei Hospital, Ede, the Netherlands.
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.
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 (25OHD3) concentration and physical performance were measured perioperatively. Linear mixed models were used to examine differences between groups.
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.
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.