Vitamin D Status and Patient Outcomes after Knee or Hip Surgery: A Meta-Analysis

Abstract

Background: This study evaluates the effect of vitamin D status in patient outcomes after hip or knee joint surgery. Method: Literature search was carried out in electronic databases, and study selection followed predetermined eligibility criteria. Data were extracted from relevant studies and meta-analyses of standardized mean differences between hypovitaminosis D (vitamin D deficiency or insufficiency) and euvitaminosis D in assessment scores of patient-reported outcomes were performed. Results: A total of 12 studies (2,593 patients; age 69.89 years [95% CI 68.07–71.70]; 35.95% [29.43–42.46] males) were included in the meta-analysis. The prevalence of hypovitaminosis D (vitamin D deficiency or insufficiency) was 33.18% [25.10–41.26], but the combined prevalence of deficiency and insufficiency was 46.99 [34.02–59.96]. Hospital stay was 1.09 days [–0.39 to 2.56] longer in the hypovitaminosis D group compared to the euvitaminosis D group. Preoperatively, Harris Hip Score (HHS) and Knee Society Score were significantly lower (p = 0.001 and p = 0.00001, respectively) in the hypovitaminosis D group than in the euvitaminosis D group. Postoperatively, HHS (p = 0.004) score was significantly lower in the hypovitaminosis D group than in the euvitaminosis D group. Conclusion: The prevalence of hypovitaminosis D is high in osteoarthritis patients undergoing knee or hip surgery. Vitamin D deficiency may affect the outcomes of orthopedic joint surgery. However, randomized trial/s will be required to confirm these findings.

Relationship between vitamin D status and clinical outcomes in dogs with a cranial cruciate ligament rupture

“…The relationship between vitamin D status and orthopaedic disorders was emphasised in a recent meta-analysis of 12 studies which examined the relationship between preoperative 25(OH)D concentrations and clinical presentation and outcomes in patients undergoing knee or hip surgery. This meta-analysis found that pre-operative Harris Hip Scores and Knee Society Score, which assess hip and knee pain and function respectively, revealed greater disease burden in patients with low vitamin D status compared to patients with a normal vitamin D status (Zhang et al, 2018). In addition, post-operative Harris Hip Score was significantly lower in the patients which were hypovitaminosis D pre-operative than in the euvitaminosis D group (Zhang et al, 2018).…”

“…This meta-analysis found that pre-operative Harris Hip Scores and Knee Society Score, which assess hip and knee pain and function respectively, revealed greater disease burden in patients with low vitamin D status compared to patients with a normal vitamin D status (Zhang et al, 2018). In addition, post-operative Harris Hip Score was significantly lower in the patients which were hypovitaminosis D pre-operative than in the euvitaminosis D group (Zhang et al, 2018). In light of the evidence that vitamin D status is linked to presentation and outcome in human elective knee surgery and the paucity of research in this area in veterinary patients, the aim of this study was to investigate the relationship between pre-operative serum 25(OH)D concentrations and presenting clinical signs and subsequent post-operative clinical outcomes.…”

“…Despite the growing interest in the role vitamin D may play in skeletal and non-skeletal health in companion animals, little work has been undertaken to explore the relationship between vitamin D status and orthopaedic disease severity and response to treatment. This contrasts to the situation in human orthopaedics where the relationship between circulating 25(OH)D concentrations and orthopaedic disorders have been extensively explored (Iglar and Hogan, 2015;Zhang et al, 2018).…”

The effect of vitamin D supplementation on outcomes following total hip or knee arthroplasty surgery: a rapid systematic review of current evidence

“…Inadequate vitamin D levels have been associated with a range of adverse post-operative outcomes ( 3 ), and there is a high incidence of deficiency reported in patients undergoing total hip (THR) or knee (TKR) arthroplasty ( 4 ). Previous systematic reviews ( 4 , 5 , 6 , 7 ) have described an association between deficiency and poorer outcomes following THR/TKR, although two meta-analyses ( 4 , 6 ) allude to the inclusion of retrospective and non-randomised studies with significant heterogeneity. No systematic review has yet addressed the role of peri-operative supplementation.…”

The role of vitamin D and vitamin D deficiency in orthopaedics and traumatology—a narrative overview of the literature

“…The prevalence of vitamin D deficiency in osteoarthritis patients undergoing knee or hip surgery is high (24,98,99). Furthermore, vitamin D levels were found to positively correlate with both pre-and post-operative Harris hip scores (99,100).…”