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Joint replacement infection associated with low vitamin D – April 2014

Is there an association between periprosthetic joint infection and low vitamin D levels?

Gerrit Steffen Maier, Konstantin Horas, Jörn Bengt Seeger, Klaus Edgar Roth, Andreas Alois Kurth, Uwe Maus
International Orthopaedics 04/2014; DOI:10.1007/s00264-014-2338-6

Vitamin D is increasingly being recognized as an important mediator of immune function and may have a preventive role in the pathogenesis of periprosthetic joint infection. To the best of our knowledge, no other study has examined possible associations between periprosthetic joint infection and vitamin D deficiency. We investigated the rate of vitamin D deficiency in patients treated for periprosthetic joint infection and whether vitamin D deficiency is independent of other risk factors for vitamin D deficiency in patients with periprosthetic joint infection.
Serum 25-hydroxyvitamin D (25OHD) levels of every patient scheduled to receive a total prosthesis either of the hip, knee, or shoulder in the orthopaedic department of the Johannes-Guttenberg-University Hospital in Mainz, Germany (109 patients), were measured after admission. Furthermore, serum 25OHD levels were measured for every patient presenting with periprosthetic joint infection (n = 50) or aseptic loosening of the prosthesis (n = 31) scheduled to undergo revision surgery. The prevalence of normal (>30 ng/ml), insufficient (20-30 ng/ml), and deficient (<20 ng/ml) 25OHD levels was determined.
All tested patient subgroups showed low vitamin D levels. Statistical analysis found no significant difference in vitamin D levels comparing patients with prosthesis and patients with aseptic prosthesis loosening (p = 0.58). Significant differences in 25OHD levels were found comparing patients with periprosthetic joint infection and patients scheduled for primary arthroplasty (p < 0.001). In addition, we found a significant difference (p < 0,001) in 25OHD levels of patients with periprosthetic joint infection compared with patients with aseptic prosthesis loosening.
We found a high frequency of vitamin D deficiency in patients being treated by primary arthroplasty and those with aseptic joint prosthetic loosening and periprosthetic joint infection. Vitamin D deficiency was severe in patients with periprosthetic joint infection.


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data from PDF
20 ng: Initial hip, shoulder or knee replacement patients:
For those who needed a second surgery
21 ng for aseptic prosthesis loosening (basically unchanged)
13 ng for patients with periprosthetic joint infection (huge decrease)

See also VitaminDWiki