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

Abstract

Purpose 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. Methods 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. Results 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. Conclusion 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.

Factors That Affect Outcome Following Total Joint Arthroplasty: a Review of the Recent Literature

“…Some of the variables that have been shown to affect the outcome after total joint replacement include social and demographic characteristics, medical comorbidities, and surgical technique [3][4][5][6][7]. Areas of continued active research include the effect of intrinsic factors such as obesity [8][9][10], cardiovascular disease [11,12], mental health disorders [13•, 14-17•, 18•, 19], hepatic disease [20, 21•, 22, 23•, 24], nutritional deficiencies [25-29•, 30], bone metabolic disease [31][32][33][34][35][36][37], and diabetes mellitus [38•, 39, 40], as well as external factors such as nicotine use [41,42], recent corticosteroid injections [43][44][45][46][47], and discharge disposition [48,49]. The goal of this article is to review the most recent literature, published within the last 3 years, regarding a selection of patient-specific factors that may influence This article is part of the Topical Collection on Quality and Cost Control in TJA outcomes following total joint arthroplasty.…”

Exploration of Serum 25-Hydroxy Vitamin D in Total Joint Arthroplasty within a Subtropical Climate

“…[2] Furthermore, a significantly higher prevalence of vitamin D deficiency was found in patients undergoing revision TJA for PJI compared to both primary TJA and aseptic loosening revision groups, with 13.29 ng/ml versus 20.52 ng/ml, respectively. [9] Interestingly, serum 25(OH)D shows an inverse relationship with C-reactive protein, although the significance of this relationship is not completely understood. [12,24] As a cross sectional analysis, this study has several inherent limitations.…”

“…[17] Furthermore, periprosthetic joint infections (PJI) show a close association with vitamin D deficiency in the arthroplasty population. [9] Emerging evidence also suggests vitamin D plays a significant role in antimicrobial activity. [7,8,18,19] Numerous advantages of maintaining appropriate serum 25(OH)D continue to emerge, however, appropriate management remains controversial.…”

“…[9,12] One study reported 77.7% of hip fracture patients had sub-normal serum 25(OH)D versus 58.6% in normal controls. [17] Furthermore, periprosthetic joint infections (PJI) show a close association with vitamin D deficiency in the arthroplasty population.…”

“…[3,4,6,7] A serum 25(OH) D within normal limits is associated with a decreased risk of microbial infections, falls, numerous cancers, multiple sclerosis, cardiovascular disease, autoimmune diseases, and diabetes mellitus. [6][7][8][9][10] Standardized management of vitamin D deficiency could potentially have profound effects on health care costs and morbidity related to countless chronic diseases. [6,11] The high prevalence of vitamin D deficiency in those undergoing orthopedic surgery is well described.…”