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Total hip replacement: 14 times more likely to redo if low vitamin D – March 2017

INFLUENCE OF VITAMIN D LEVELS ON REVISION AND COMPLICATION RATES FOLLOWING TOTAL JOINT ARTHROPLASTY

Orthopaedic Proceedings, vol. 99-B no. SUPP 5 88 1 March 2017
J.F. Plate, T.M. Seyler, A.D. Wohler, M.K. Langfitt, J.E. Lang
Wake Forest School of Medicine - Winston-Salem, USA jplate at wakehealth.edu

VitaminDWiki

Brief summary of many studies on hip fractures and vitamin D
1) Having a high level of vitamin D greatly reduces the risk of hip fractures
2) A hip fracture consumes vitamin D
3) Far fewer complications after hip fracture if add sun/uv or vitamin D
4) 14X more likely to need revision surgery within 3 years if Vitamin D remains < 30 ng (this study)

See also VitaminDWiki

Introduction Vitamin D deficiency is common in patients undergoing total hip (THA) or total knee arthroplasty (TKA) which may affect prosthesis survival and 90-day readmission rates. The purpose of this study was to assess whether preoperative Vitamin D deficiency or insufficiency have an influence on revision, readmission, and complication rates following THA and TKA. We hypothesized that low Vitamin D levels in patients undergoing THA and TKA have a negative effect on revision rates.

Methods Patients who underwent primary THA or TKA in a 2-year period university hospital were identified and stratified into 3 groups based on preoperative 25-hydroxyvitamin D serum levels: normal levels of 30 ng/ml or greater, (2) deficient levels of 20–29.9 ng/ml, and (3) insufficient levels of less than 20 ng/ml. Patient demographics and postoperative course were collected from the electronic medical record.

Results This study found that 45% out of 197 THA had Vitamin D levels less than 30ng/ml and significantly higher odds (14.1, p=0.018) of requiring revision surgery at a mean follow-up of 34 ± 11.2 months. Out of 167 TKA, 46% were Vitamin deficient/insufficient without an influence on revision rate. Vitamin D levels did not influence 90-day readmissions, wound complications, or reaching discharge goals. Low Vitamin D levels correlated with high BMI and young patient age for THA.

Conclusion Based on the findings of this study, the authors recommend preoperative Vitamin D3 supplementation (2,000–4,000 IU daily) for patients with a BMI greater than 30kg/m2 undergoing THA. Patient with Vitamin D deficiency may require referral for endocrinologic work-up. Based on the findings of this study, the authors have adopted postoperative Vitamin D3 supplementation with 2,000–4,000 IU daily for 3 months as part of the rehabilitation protocol for all patients undergoing THA.

Copyright © 2017, British Editorial Society of Bone & Joint Surgery

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