Feature Article
Preoperative Vitamin D Deficiency Is Associated With Higher Postoperative Complication Rates in Total Knee Arthroplasty
Orthopedics, 2018;41(4):e489–e495
Cite this articlePublished Online:April 24, 2018https://doi.org/10.3928/01477447-20180424-04Cited by:37
Abstract
The purpose of this study was to determine the relative incidence of postoperative complications in 25-hydroxyvitamin D (25D)-deficient and -sufficient patients undergoing total knee arthroplasty (TKA). Patients who were either serum 25D deficient (25D <20 ng/mL) or 25D sufficient (25D ≥20 ng/mL) 90 days prior to primary TKA from 2007 to 2016 were identified using the Humana administrative claims registry. The incidence of postoperative medical and surgical complications was determined by querying for relevant International Classification of Diseases, Ninth Revision and Current Procedural Terminology codes. Risk-adjusted odds ratios (ORs) were calculated using multivariate logistic regression with age, sex, and Charlson Comorbidity Index as covariates. In total, 868 of 6593 patients who underwent TKA from 2007 to 2016 were 25D deficient, corresponding to a 13.2% prevalence rate. On adjustment for age, sex, and Charlson Comorbidity Index, 25D-deficient patients had a higher incidence of postoperative stiffness requiring manipulation under anesthesia (OR, 1.69; 95% confidence interval [CI], 1.39–2.04; P<.001), surgical site infection requiring irrigation and debridement (OR, 1.76; 95% CI, 1.25–2.48; P=.001), and prosthesis explantation (OR, 2.97; 95% CI, 2.04–4.31; P<.001) at 1 year. Patients who were 25D deficient also had higher rates of postoperative deep venous thrombosis (OR, 1.80; 95% CI, 1.36–2.38; P<.001), myocardial infarction (OR, 2.11; 95% CI, 1.41–3.15; P<.001), and cerebrovascular accident (OR, 1.73; 95% CI, 1.17–2.57; P=.006). Thus, serum 25D levels below 20 ng/mL are associated with a higher incidence of postoperative complications and may be a perioperative modifiable risk factor in TKA. [Orthopedics. 2018; 41(4):e489–e495.]
- 1.Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am. 2007; 89(4):780–785. > Crossref MedlineGoogle Scholar
- 2.Schwartz FH, Lange J. Factors that affect outcome following total joint arthroplasty: a review of the recent literature. Curr Rev Musculoskelet Med. 2017; 10(3):346–355.
10.1007/s12178-017-9421-8 > Crossref MedlineGoogle Scholar - 3.Nawabi DH, Chin KF, Keen RW, Haddad FS. Vitamin D deficiency in patients with osteoarthritis undergoing total hip replacement: a cause for concern?J Bone Joint Surg Br. 2010; 92(4):496–499.
10.1302/0301-620X.92B3.23535 > Crossref MedlineGoogle Scholar - 4.Jansen JA, Haddad FS. High prevalence of vitamin D deficiency in elderly patients with advanced osteoarthritis scheduled for total knee replacement associated with poorer preoperative functional state. Ann R Coll Surg Engl. 2013; 95(8):569–572.
10.1308/rcsann.2013.95.8.569 > Crossref MedlineGoogle Scholar - 5.Unnanuntana A, Saleh A, Nguyen JT, Low vitamin D status does not adversely affect short-term functional outcome after total hip arthroplasty. J Arthroplasty.2013; 28(2):315–322.
10.1016/j.arth.2012.04.027 > Crossref MedlineGoogle Scholar - 6.Lavernia CJ, Villa JM, Iacobelli DA, Rossi MD. Vitamin D insufficiency in patients with THA: prevalence and effects on outcome. Clin Orthop Relat Res. 2014; 472(2):681–686.
10.1007/s11999-013-3172-7 > Crossref MedlineGoogle Scholar - 7.Inkrott BP, Koberling JL, Noel CR. Hypovitaminosis D in patients undergoing shoulder arthroplasty: a single-center analysis. Orthopedics. 2016; 39(4):e651–e656.
10.3928/01477447-20160606-04 > LinkGoogle Scholar - 8.Goula T, Kouskoukis A, Drosos G, Vitamin D status in patients with knee or hip osteoarthritis in a Mediterranean country. J Orthop Traumatol. 2015; 16(1):35–39.
10.1007/s10195-014-0322-y > Crossref MedlineGoogle Scholar - 9.Tran EY, Uhl RL, Rosenbaum AJ. Vitamin D in orthopaedics. JBJS Rev. 2017; 5(8):e1.
10.2106/JBJS.RVW.16.00084 > Crossref MedlineGoogle Scholar - 10.Fabri M, Stenger S, Shin DM, Vitamin D is required for IFN-gamma-mediated antimicrobial activity of human macrophages. Sci Transl Med. 2011; 3(104):104ra102.
10.1126/scitranslmed.3003045 > Crossref MedlineGoogle Scholar - 11.Adams JS, Liu PT, Chun R, Modlin RL, Hewison M. Vitamin D in defense of the human immune response. Ann N Y Acad Sci. 2007; 1117(1):94–105.
10.1196/annals.1402.036 > Crossref MedlineGoogle Scholar - 12.Liu PT, Stenger S, Li H, Toll-like receptor triggering of a vitamin D-mediated human antimicrobial response. Science. 2006; 311(5768):1770–1773.
10.1126/science.1123933 > Crossref MedlineGoogle Scholar - 13.Adams JS, Ramin J, Rafison B, Windon C, Windon A, Liu PT. Redefining human vitamin D sufficiency: back to the basics. Bone Res. 2013; 1(1):2–10.
10.4248/BR201301002 > Crossref MedlineGoogle Scholar - 14.Baeke F, Takiishi T, Korf H, Gysemans C, Mathieu C. Vitamin D: modulator of the immune system. Curr Opin Pharmacol. 2010; 10(4):482–496.
10.1016/j.coph.2010.04.001 > Crossref MedlineGoogle Scholar - 15.Kamen DL, Tangpricha V. Vitamin D and molecular actions on the immune system: modulation of innate and autoimmunity. J Mol Med (Berl). 2010; 88(5):441–450.
10.1007/s00109-010-0590-9 > Crossref MedlineGoogle Scholar - 16.Schauber J, Dorschner RA, Coda AB, Injury enhances TLR2 function and antimicrobial peptide expression through a vitamin D-dependent mechanism. J Clin Invest. 2007; 117(3):803–811.
10.1172/JCI30142 > Crossref MedlineGoogle Scholar - 17.Jetter A, Egli A, Dawson-Hughes B, Pharmacokinetics of oral vitamin D(3) and calcifediol. Bone. 2014; 59:14–19.
10.1016/j.bone.2013.10.014 > Crossref MedlineGoogle Scholar - 18.da Cunha BM, Gava AD, de Oliveira SB, de David AC, Dos Santos-Neto LL. Vitamin D is related to gait recovery after total hip arthroplasty: a prospective analysis. Gait Posture. 2016; 50:96–101.
10.1016/j.gaitpost.2016.08.014 > Crossref MedlineGoogle Scholar - 19.Shin KY, Park KK, Moon SH, Yang IH, Choi HJ, Lee WS. Vitamin D deficiency adversely affects early post-operative functional outcomes after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2017; 25(11):3424–3430.
10.1007/s00167-016-4209-8 > Crossref MedlineGoogle Scholar - 20.Lee A, Chan SK, Samy W, Chiu CH, Gin T. Effect of hypovitaminosis D on postoperative pain outcomes and short-term health-related quality of life after knee arthroplasty: a cohort study. Medicine (Baltimore). 2015; 94(42):e1812.
10.1097/MD.0000000000001812 > Crossref MedlineGoogle Scholar - 21.Maniar RN, Patil AM, Maniar AR, Gangaraju B, Singh J. Effect of preoperative vitamin D levels on functional performance after total knee arthroplasty. Clin Orthop Surg.2016; 8(2):153–156.
10.4055/cios.2016.8.2.153 > Crossref MedlineGoogle Scholar - 22.Maier GS, Maus U, Lazovic D, Horas K, Roth KE, Kurth AA. Is there an association between low serum 25-OH-D levels and the length of hospital stay in orthopaedic patients after arthroplasty?J Orthop Traumatol. 2016; 17(4):297–302.
10.1007/s10195-016-0414-y > Crossref MedlineGoogle Scholar - 23.Traven SA, Chiaramonti AM, Barfield WR, Fewer complications following revision hip and knee arthroplasty in patients with normal vitamin D levels. J Arthroplasty. 2017; 32(9S):S193–S196.
10.1016/j.arth.2017.02.038 > Crossref MedlineGoogle Scholar - 24.Maier GS, Horas K, Seeger JB, Roth KE, Kurth AA, Maus U. Is there an association between periprosthetic joint infection and low vitamin D levels?Int Orthop. 2014; 38(7):1499–1504.
10.1007/s00264-014-2338-6 > Crossref MedlineGoogle Scholar - 25.Hatfield DP, Sweeney KP, Lau J, Lichtenstein AH. Critical assessment of high-circulation print newspaper coverage of the Institute of Medicine report Dietary Reference Intakes for Calcium and Vitamin D. Public Health Nutr. 2014; 17(8):1868–1876.
10.1017/S1368980013002073 > Crossref MedlineGoogle Scholar - 26.Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987; 40(5):373–383.
10.1016/0021-9681(87)90171-8 > Crossref MedlineGoogle Scholar - 27.Tiosano D, Wildbaum G, Gepstein V, The role of vitamin D receptor in innate and adaptive immunity: a study in hereditary vitamin D-resistant rickets patients. J Clin Endocrinol Metab. 2013; 98(4):1685–1693.
10.1210/jc.2012-3858 > Crossref MedlineGoogle Scholar - 28.Pepper KJ, Judd SE, Nanes MS, Tangpricha V. Evaluation of vitamin D repletion regimens to correct vitamin D status in adults. Endocr Pract. 2009; 15(2):95–103.
10.4158/EP.15.2.95 > Crossref MedlineGoogle Scholar - 29.Unnanuntana A, Rebolledo BJ, Gladnick BP, Does vitamin D status affect the attainment of in-hospital functional milestones after total hip arthroplasty?J Arthroplasty. 2012; 27(3):482–489.
10.1016/j.arth.2011.05.023 > Crossref MedlineGoogle Scholar - 30.Jansen JA, Haddad FS. High prevalence of vitamin D deficiency in elderly patients with advanced osteoarthritis scheduled for total knee replacement associated with poorer preoperative functional state. Ann R Coll Surg Engl. 2013; 95(8):569–572.
10.1308/rcsann.2013.95.8.569 > Crossref MedlineGoogle Scholar - 31.Mäkinen TJ, Alm JJ, Laine H, Svedström E, Aro HT. The incidence of osteopenia and osteoporosis in women with hip osteoarthritis scheduled for cementless total joint replacement. Bone. 2007; 40(4):1041–1047.
10.1016/j.bone.2006.11.013 > Crossref MedlineGoogle Scholar - 32.Walsh JS, Bowles S, Evans AL. Vitamin D in obesity. Curr Opin Endocrinol Diabetes Obes.2017; 24(6):389–394.
10.1097/MED.0000000000000371 > Crossref MedlineGoogle Scholar - 33.Zostautiene I, Jorde R, Schirmer H, Genetic variations in the vitamin D receptor predict type 2 diabetes and myocardial infarction in a community-based population: the Tromsø Study. PLoS One. 2015; 10(12):e0145359.
10.1371/journal.pone.0145359 > Crossref MedlineGoogle Scholar - 34.Wang TJ, Pencina MJ, Booth SL, Vitamin D deficiency and risk of cardiovascular disease. Circulation. 2008; 117(4):503–511.
10.1161/CIRCULATIONAHA.107.706127 > Crossref MedlineGoogle Scholar - 35.Hejazi ME, Modarresi-Ghazani F, Hamishehkar H, Mesgari-Abbasi M, Dousti S, Entezari-Maleki T. The effect of treatment of vitamin D deficiency on the level of P-selectin and hs-CRP in patients with thromboembolism: a pilot randomized clinical trial. J Clin Pharmacol. 2017; 57(1):40–47.
10.1002/jcph.774 > Crossref MedlineGoogle Scholar
