High prevalence and seasonal variation of hypovitaminosis D in patients scheduled for lower extremity total joint arthroplasty

Abstract

Background: High rates of vitamin D insufficiency and deficiency have been demonstrated in various patient populations, including patients undergoing total joint arthroplasties (TJA). However, the risk factors associated with this condition and its seasonal variation is still to be determined in patients scheduled for elective TJA. Methods: We retrospectively identified 226 (116 hips, 120 knees) patients who underwent primary TJA, and had a vitamin D measurement, at a single institution (latitude, 41° 30' N) from 2006 to 2016. Demographics, comorbidities, and perioperative data were collected from electronic medical records. Patients were stratified into vitamin D sufficient (≥30 ng/mL), insufficient (<30 ng/mL), and deficient group (<20 ng/mL). Multivariate regression analyses were used to study the risk factors for vitamin D insufficiency and deficiency. Results: There were 99/226 (43.8%) patients in the vitamin D sufficient group, 137/226 patients (60.6%) in the insufficient group, of which 61/226 (26.9%) were in the deficient group. On multivariate analysis, an American Society of Anesthesiologists' (ASA) score ≥3 was a risk factor for vitamin D insufficiency (P<0.001), while ASA ≥3 (P<0.001) and younger age (P=0.002) were risk factors for vitamin D deficiency. Vitamin D levels varied between the quarters with lowest level seen in quarter 1 (P=0.015). Conclusions: There was an overall high prevalence of vitamin D insufficiency (60%) and deficiency (27%). Due to higher risk of hypovitaminosis D, particular attention should be placed in patients with an ASA score ≥3, and patients scheduled during winter season.

Malnutrition in Orthopaedic Sports Medicine: A Review of the Current Literature

“…4,24,32 Furthermore, vitamin D receptors have been found on myocytes, which may act as a modulator of cell growth, neuromuscular function, and immunomodulation. 60 After anterior cruciate ligament reconstruction (ACLR), muscle (quadriceps) weakness is an immediate and persistent impairment that can predispose patients to developing degenerative joint disease and requiring subsequent surgeries later in life. To explore the potential clinical therapeutic benefit of vitamin D to combat these changes in the postoperative setting, Barker et al 8 measured changes in peak isometric forces in the injured limb of patients undergoing ACLR in vitamin D-insufficient (<30 ng/mL) and sufficient (≥30 ng/mL) patients.…”

“…73 Vitamin D deficiency and insufficiency, defined as <20 ng/mL and <30 to 32 ng/mL, respectively, are highly prevalent in patients undergoing orthopaedic procedures. 11,60 Second only to trauma patients, Bogunovic et al 11 demonstrated a 52.3% rate of vitamin D insufficiency in orthopaedic sports medicine patients.…”

“…4,24,32 Furthermore, vitamin D receptors have been found on myocytes, which may act as a modulator of cell growth, neuromuscular function, and immunomodulation. 60…”

Roth’s Spots, a clinical diagnostic clue for Infective Endocarditis

“…73 Most research, however, demonstrates little evidence to support hypovitaminosis D as a risk factor linked to reduced postoperative functional recovery or increased risk of PJIs. 74,75 Some orthopedists nevertheless recommend screening and treating hypovitaminosis D prior to undergoing orthopaedic surgery. 74 When recommended, a standard vitamin D regimen consists of 50,000 units of vitamin D 3 weekly for 6 to 8 weeks to increase low levels to an optimal level of 30 to 60 ng/mL.…”

Vitamin D Deficiency in Patients With Idiopathic and Traumatic Osteochondritis Dissecans of the Talus

“…13,15 In recent years, several studies have demonstrated that vitamin D deficiency is highly prevalent in orthopedic patients. 20,23,30 Moreover, we and others have shown that vitamin D deficiency also affects patients with foot and ankle disorders. 1,16,32,33 Further, it has been suggested that hypovitaminosis D is related to the onset of OCD.…”