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
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
- Better total hip replacement if have high vitamin D
- Death of older hip fracture patients at least 1.6X more likely if low vitamin D – May 2018
- Perhaps fewer bone non-unions with 100,000 IU weekly of vitamin D – RCT 2018
- Hip replacement 2X more likely if hip bone surgery was during winter (low vitamin D) – Dec 2014
- Hip fractures reduced 2X to 6X with just 10 minutes of sunlight daily – RCT 2003-2010
- Guideline following hip fracture – 50000 IU vitamin D daily for 7 days – Jan 2013
- Vitamin D and exercise after hip fracture surgery – far fewer deaths – July 2016
- 24 years ago hip fractures were reduced 24 percent in a large trial using Vitamin D and Ca – Oct 2016
- Wonder how many more decades until doctors will recommend Vitamin D following hip surgery
- My wife had partial hip replacement due to a big fall in 2016, but her surgeon, doctors, and hospital did not mention Vitamin D
- Hospital found that Vitamin D saves money by improving bone fracture healing– March 2016
- Unfortunately many hospitals realize that they get more business/income if they do NOT recommend vitamin D
- However, a Insurance company will save lots of money if they can get the hip surgery patient to add vitamin D
- Bone fractures healed much better if more than 20ng of vitamin D – Sept 2016
- One pill every two weeks gives you all the vitamin D most adults need
- $5/year of vitamin D greatly reduces the risk of any bone fracture
- Total knee arthroplasty – worse outcome if low vitamin D – 2016, 17, 18, 2019
- Hip surgery with multiple doses of 50,000 IU of vitamin D weekly both before and after – RCT 2023
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