Vitamin D Trajectory after Total Knee Arthroplasty: A Method for Quick Correction in Deficient Patients
Clin Orthop Surg. 2021 Sep;13(3):336-343. doi: 10.4055/cios20147
Rajesh N Maniar 1 2, Adit R Maniar 1 2, Ditesh Jain 1, Nishit Bhatnagar 3, Arpit Gajjar 4
Note: Sometimes the 600,000 IU injections actually REDUCED vitamin D levels
After Total Knee Arthroplasty
- None needed, none given
- Deficient - 600,000 IU injection
- Deficient - 600,000 IU oral
When to use injection
Patient can not be depended on to take Vitamin D periodically over a peropd or months
Poor gut (there are other solutions)
When NOT to use injection
Vitamin D levels need to be increased quckly
Cannot afford the 20X increase in injection cost over oral cost
Injection contains the following
- Vitamin D injections last longer (3 month vs 2 month) than loading doses
- Getting Vitamin D into your body shows the many ways of getting Vitamin D
- Injections are currently made by medical professionals into muscle
- Home injection of Vitamin D appears to be possible in the future
- Injections are useful for people who might forget to take their periodic supplement (children, elderly, etc) and those who cannot swallow or have poor digestion
- While Vitamin D2 is historically the common form, Vitamin D3 is far better
- Should check (if there is time) for possible allergic reaction to Vitamin D or lack of Magnesium for both for loading dose and injection
- Note 600,000 IU Vitamin D loading dose via capsules is 1/20th the cost($2.40) of an injection, and does not require a prescription
- 100,000 IU single dose of vitamin D - 2010 has the following
- Vitamin D injection lasts longer and has bigger response than weekly oral – Jan 2017 has the following
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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