Total knee arthroplasty – worse outcome if low vitamin D – many studies

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Should add vitamin D before TKA - Dec 2024

Prevalence and Associated Risk Factors for Hypovitaminosis D in Patients Scheduled for Primary Total Knee Arthroplasty in Germany
Nutrients 2024, 16(23), 3991; https://doi.org/10.3390/nu16233991
by Tizian Heinz 1,*,Miledi Hoxha 1,Philip Mark Anderson 1,Axel Jakuscheit 1ORCID,Manuel Weißenberger 1,Martin Lüdemann 1,Dominik Rak 1ORCID,Maximilian Rudert 1 andKonstantin Horas 1,2

Objective: Several studies have reported a high prevalence of hypovitaminosis D in orthopedic patients. The purpose of this prospective observational study was to report on the prevalence of hypovitaminosis D in patients scheduled for elective primary total knee arthroplasty (TKA) and its associated risk factors.

Methods: In this monocentric cohort study, 25(OH) vitamin D serum levels were measured in 687 consecutive patients undergoing primary total knee arthroplasty (TKA) over a period of twelve months. Vitamin D levels were classified into deficiency (<20 ng/mL), insufficiency (20–29 ng/mL), and sufficiency (≥30 ng/mL). The study assessed the association of vitamin D levels with demographic and clinical factors, including age, sex, BMI, smoking status, and season of measurement. Statistical analyses included chi-square tests, correlation analyses, and multiple linear regression to identify significant predictors of vitamin D levels.

Results: The cohort had a mean age of 67.70 ± 8.95 years and a mean BMI of 31.00 ± 5.71 kg/m2. Collectively, 33.9% of patients were vitamin D deficient, a further 32.9% were insufficient, and only 33.2% were sufficient. Vitamin D levels varied significantly with the season and were associated with obesity and smoking. Specifically, there was a small significant inverse correlation between BMI and vitamin D levels (r = −0.17, p < 0.01). Furthermore, regular nicotine abuse was linked to lower vitamin D levels (r = 0.14, p < 0.01). Multiple linear regression analysis reveals that age, BMI, nicotine abuse, and season were small significant predictors of preoperative vitamin D levels (R2 = 0.15, adjusted R2 = 0.12). A total of 121 (17.61%) patients reported routine vitamin D intake prior to surgery. Supplementing patients had a significantly higher mean serum vitamin D level and a significant reduction in the mean length of in-hospital stay (p < 0.01).

Conclusions: The prevalence of vitamin D insufficiency and deficiency in patients undergoing elective primary TKA is alarmingly high. In ongoing efforts to optimize the efficacy and outcome of the TKA procedure, orthopedic surgeons should be advised to strongly implement the role of perioperative vitamin D levels in their routine practice.
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TKA with enough Vitamin D: 1/2 day shorter hospital time, quicker recovery - meta-analysis April 2024

Vitamin D Deficiency Leads to Poorer Health Outcomes and Greater Length of Stay After Total Knee Arthroplasty and Supplementation Improves Outcomes: A Systematic Review and Meta-Analysis
JBJS Rev. 2024 Apr 4;12(4). doi: 10.2106/JBJS.RVW.23.00150
Kavyesh Vivek 1, Rayan Kamal 1, Edward Perera 2, Chinmay M Gupte 1 2

Background: Vitamin D deficiency is increasingly identified as a predictor of poorer outcomes in musculoskeletal disease affecting as many as 1 in 4 people. This study aimed to evaluate the effect of vitamin D supplementation on outcomes after primary total knee arthroplasty (TKA).

Methods: A targeted search of terms related to vitamin D and TKA outcomes was performed in PubMed, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, American Academy of Orthopaedic Surgeons, and British Orthopaedic Association databases. The results were analyzed using forest plots with I2 heterogeneity statistics and pooled effects with 95% confidence intervals (CIs) and p values. A p < 0.05 was considered statistically significant.

Results: A total of 146,054 patients with 150,107 TKRs were analyzed in 10 studies that complied with the inclusion criteria, of which 3 were suitable for meta-analysis. Of these, 4 of the 10 studies showed that vitamin D deficiency resulted in poorer functional outcome scores (Western Ontario and McMasters Universities Osteoarthritis Index, Knee Society Scoring System, and American Knee Society scores), as well as increased risk of revision surgery, incidence of joint infection, and postoperative stiffness. Meta-analysis of length of hospital stay (LOS) demonstrated a significant increase in LOS in patients with vitamin D deficiency (standardized mean difference, -0.54, 95% CI, -0.69 to -0.38, p < 0.00001). Furthermore, outcomes were improved with vitamin D supplementation in 6 of 10 studies.

Conclusion: Vitamin D deficiency results in poorer outcomes of primary TKA, with improved outcomes after supplementation. Further studies should examine the role of preoperative vitamin D screening and/or perioperative supplementation in primary TKA and standardize outcome measures to assess their effect.

Level of evidence: Level I/II. See Instructions for Authors for a complete description of levels of evidence.
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Better outcome if > 30 ng before TKA surgery Pakistan April 2019

EFFECT OF PRE-OPERATIVE SERUM VITAMIN-D LEVELS ON POST-OPERATIVE OUTCOME IN TOTAL KNEE ARTHROPLASTY
Junaid Khan, Riaz Ahmed, Rahman Rasool Akhtar
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Objective: To determine the effect of pre-operative serum vitamin-D levels on the post-operative outcome in patients undergoing total knee arthroplasty.

Methodology: This prospective cohort study was conducted at the Department of Orthopaedics, Benazir Bhutto Hospital, Rawalpindi, Pakistan from 11th May 2017 to 10th May 2018. A total of 110 patients undergoing primary unilateral total knee arthroplasty (TKA) were enrolled in the study. Patients were placed into two groups. Group A included patients who had deficient vitamin-D3 levels (<30 ng/ml) while group B had patients with sufficient levels of vitamin-D3 (≥30 ng/ml). Functional evaluation was done pre-operatively and at 03 months post-operatively using American knee society score (KSS), Alternate step test (AST) and Six-meter walk test (SWT). Mean functional scores were compared using student’s t-test in SPSS version 23.

Results: There were 48 (43.64%) male and 62 (56.36%) female patients. Mean age of patients in group A was 60.87 ±5.10 years while in group B it was 60.09 ±4.78 years. Group A patients had mean vitamin-D levels of 13.56 ±6.12 ng/ml and those in group B had 41.49 ±9.95 ng/ml. At 3 months post-op, functional KSS showed a significant difference between the two groups (

• 65.98 ±5.10 in group A and (<30 ng)
• 74.87 ±5.02 in group B, p <0.01). (> 30ng)

The performance tests showed significant difference between the 02 groups (16.46 ±2.78 vs. 15.12 ±3.37, p =0.02 for AST) while (8.48 ±2.06 vs. 7.49 ±1.88, p =0.01, for SWT), respectively.

Conclusion: Pre-operative vitamin-D levels significantly affect the post-operative functional outcome in TKA.

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Knee Arthroplasty complications were 2 X more likely if low vitamin D -May 2018

• Knee Arthroplasty complications were 2 X more likely if low vitamin D -May 2018

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Better total knee arthroplasty outcomes if higher Vitamin D Levels - June 2016

Vitamin D deficiency adversely affects early post-operative functional outcomes after total knee arthroplasty
Knee Surgery, Sports Traumatology, Arthroscopy, pp 1–7, First Online: 17 June 2016
Keun-Young ShinKwan Kyu ParkSeong-Hwan MoonIck Hwan YangHo-June ChoiWoo-Suk Lee

Purpose
Vitamin D has received considerable attention in recent years owing to the increasing evidence of its importance in muscle function and physical performance. The present study attempted to determine whether patients with low serum vitamin D levels had impairment in early functional outcomes following total knee arthroplasty (TKA).

Methods
This was a prospective cohort study that included 92 patients. Patients were divided into two groups according to their vitamin D levels as assessed at the preoperative visit: (1) vitamin D-deficient group, serum 25-hydroxyvitamin D3 (25(OH)D) levels <12 ng/mL; (2) vitamin D non-deficient group, serum 25(OH)D levels ≥12 ng/mL. American Knee Society Score (KSS) and four other performance tests including the alternative step test (AST), six-metre walk test (SMT), sit-to-stand test (STS), and timed up and go test (TUGT) were used for assessment of post-operative function. All assessments were performed one day before and three months after TKA.

Results
Of the 92 patients included in the study, 87 patients performed all required assessments. The mean post-operative functional KSS was significantly lesser in the vitamin D-deficient group than in the vitamin D non-deficient group (67.2 vs. 73.4, p = 0.031). The mean values of time taken for post-operative AST (16.6 vs. 14.6 s, p = 0.033) and SMT (8.8 vs. 7.7 s, p = 0.012) were significantly longer in the vitamin D-deficient group than in the vitamin D non-deficient group. Post-operative STS and TUGT demonstrated higher values for mean time taken in the vitamin D-deficient group than in the vitamin D non-deficient group, but these were not statistically significant (13.6 vs. 12.4 s, not significant (n.s.); 12.7 vs. 11.7 s, n.s., respectively).

Conclusion
Early post-operative functional outcomes following TKA appear to be adversely affected by vitamin D deficiency.

Level of evidence: Prospective cohort study, Level II.

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Better Knee Osteoarthritis Outcomes if has higher vitamin D levels - May 2017

Maintaining Vitamin D Sufficiency Is Associated with Improved Structural and Symptomatic Outcomes in Knee Osteoarthritis
The American Journal of Medicine, online 24 May 2017, https://doi.org/10.1016/j.amjmed.2017.04.038

Background
The aim of this study was to describe whether maintaining sufficient serum vitamin D levels in people with knee osteoarthritis and baseline vitamin D insufficiency has an association with change in knee structures and symptoms over 2 years.

Methods
Participants (n = 413, mean age 63.2 years) with symptomatic knee osteoarthritis and vitamin D insufficiency were enrolled in a clinical trial. In all, 340 participants (82.3%) completed the study, with 25-hydroxyvitamin D [25(OH)D] measurements at baseline and months 3 and 24. Participants were classified as consistently insufficient [serum 25(OH)D ≤50 nmol/L at months 3 and 24, n = 45], fluctuating [25(OH)D >50 nmol/L at either point, n = 68), and consistently sufficient [[25(OH)D >50 nmol/L at months 3 and 24, n = 226] groups. Knee cartilage volume, cartilage defects, bone marrow lesions, and effusion-synovitis volume were assessed using MRI at baseline and month 24. Knee symptoms were assessed at baseline and months 3, 6, 12, and 24 using the Western Ontario and McMaster Universities Arthritis Index.

Results
The consistently sufficient group had significantly less loss of tibial cartilage volume (β 2.1%; 95% confidence interval [CI], 0.3%, 3.9%), less increase in effusion-synovitis volume (β −2.5 mL; 95 CI%, −4.7, −0.2 mL), and less loss of Western Ontario and McMaster Universities Arthritis Index physical function (β −94.2; 95% CI, −183.8, −4.5) compared with the consistently insufficient group in multivariable analyses. In contrast, there were no significant differences in these outcomes between the fluctuating and consistently insufficient groups. Changes in cartilage defects, bone marrow lesions, and knee pain were similar between groups.

Conclusion
This post hoc analysis suggests beneficial effects of maintaining vitamin D sufficiency on cartilage loss, effusion-synovitis, and physical function in people with knee osteoarthritis.

Publisher wants $36 for the PDF

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VitaminDWiki – Trauma and surgery category contains:

Trauma and Surgery category has 352 articles

Large dose Vitamin D before surgery was found to help by 35 studies
Vitamin D is needed before most surgeries – many studies and RCTs
4.8 X more likely to die within 28 days of ICU if low Vitamin D - Jan 2024
Sepsis is both prevented and treated by Vitamin D - many studies
Thyroidectomy and Vitamin D - many studies
Orthopaedic surgeries need Vitamin D – many studies
Cancer - After diagnosis   chemotherapy
TBI OR "Traumatic Brain Injury - 21 in title as of Sept 2022
Superbug (Clostridium difficile) Infections strongly associated with low vitamin D - many studies
Glutamine and Omega-3 have also been proven to help several traumas/surgeries
   Note: Vitamin D also prevents the need for various surgeries and Omega-3 prevents many concussions/TBI
Trauma and Surgery is associated with 22 other VitaminDWiki categories
  Such as loading dose 33, Mortality 23, Infant-Child 21 Intervention 19 Cardiovascular 13, Injection 13 in Sept 2022

Did you know?

• You can easily improve outcomes of many planned surgeries by increasing vitamin D ahead of time
  • Cancer surgery is the only known exception - extra Vitamin D is OK only if doctor reduces the chemo doses
• A loading dose of Vitamin D also improves unplanned hospital admissions
• Improvements include
  • Shorter recovery time
  • Shorter ICU time
  • Reduced deaths – in hospital, next month, next year
  • Reduced Sepsis = blood poisoning = infection

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