The Effect of Perioperative Vitamin D Levels on the Functional, Patient-Related Outcome Measures and the Risk of Infection Following Hip and Knee Arthroplasty: A Systematic Review

Abstract

Introduction

The aim of this study was to evaluate the effect of perioperative vitamin D levels in terms of functional results, patient-related outcome measures (PROMs) and infection risk after hip or knee replacement.

Materials and Methods

A systematic search in PubMed, Cochrane library, ScienceDirect and ClinicalTrials.gov was conducted according to the PRISMA guidelines from inception to January 2020.

Results

Eighteen studies with more than 8000 knee and 1500 hip joint arthroplasties were included. The mean follow-up ranged from 6 weeks to 1 year and mean patients’ age from 59.4 to 76 years. Hypovitaminosis was diagnosed in 26.7% of cases. Most studies did not find significant differences in pre- and postoperative functional results, PROMs and length of hospital stay between hypovitaminosis and euvitaminosis groups. Deficient patients may be at higher risk of postoperative joint stiffness. Patients suffering from hip and knee periprosthetic joint infection seem to have lower vitamin D levels compared to those with aseptic loosening of implants.

Conclusion

The necessity of pre-operative correction of vitamin D levels to achieve better functional results and minimize the risk of infection following hip and knee arthroplasty remains inconclusive. Extend of exposure to low vitamin D levels and comparison between outliers needs further evaluation.

Keywords:

• vitamin D
• hip arthroplasty
• THA
• knee arthroplasty
• TKA

Abbreviations

TJA, total joint arthroplasty; PROMs, patient-related outcome measures; PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses; LOS, length of stay; NOS: Newcastle – Ottawa Scale; WOMAC, Western Ontario and McMaster Universities Osteoarthritis Index; KSS, Knee Society Score; SFPCS, 12-Item Short Form Survey mental component summary; SFMCS, 12-Item Short Form Survey physical component summary; AST, alternative step test; TUGT, timed up and go test; SMT, six-meter walk test; STS, sit to stand test; ABC, Activities-specific Balance Confidence Scale; 25(OH)D₃, 25-hydroxyvitamin D₃; HHS, Harris Hip Score; CST, Chair Stand Test; 10MWT,10 Meter Walking Test; SF36, 36-Item Short Form Survey; TKA, total knee arthroplasty; THA, total hip arthroplasty; PJI, periprosthetic joint infection.

Acknowledgments

Τhe authors would like to thank Theodora Panagiotidou for proofreading the article.

Author Contributions

All authors made substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; took part in drafting the article or revising it critically for important intellectual content; agreed to submit to the current journal; gave final approval of the version to be published; and agree to be accountable for all aspects of the work.

Disclosure

The authors declare that they have no conflict of interest.

Additional information

Funding

No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.