Effect of Vitamin D Status and Repletion on Postoperative Total Joint Arthroplasty Complications

Principal Investigator: Dr. Antonia Chen

Authors: Daniel Lamanna, Prabhavi Denagamage, Brielle Antonelli, Antonia Chen
Lay Abstract

Introduction
Total joint arthroplasty patients are commonly Vitamin D insufficient (serum levels <30ng/mL), which is associated with increased risk of postoperative complications. This randomized controlled trial aims to determine if preoperative correction of hypovitaminosis D in TJA patients reduces postoperative complications.

Methods
Eligible TJA patients with serum vitamin D concentrations >30ng/mL formed the control group, and those with levels between 10–30ng/mL were randomized to low- or high-dose supplementation. Serum vitamin D levels were measured on the date of surgery for supplemented patients, and were followed up at 3 months. T-tests were used to compare differences between groups. Fisher’s exact test determined if there was a difference in emergency department visits between supplemented groups.

Results
Control patients presented with a mean preoperative Vitamin D level of 42.23 ng/mL±10.76. The low-dose supplementation group had a mean preoperative vitamin D of 21.67ng/mL±5.37 and a postoperative level of 33.8ng/mL±7.73. The high-dose supplementation group had a mean preoperative vitamin D level of 24.08ng/mL±4.54 and a postoperative level of 33.8ng/mL±11.52. There were no statistically significant differences in emergency department visits between cohorts (p=0.39).

Conclusion
Both Vitamin D supplementation regimens increased serum vitamin D to sufficient levels in low vitamin D patients with similar complications.

Scientific Abstract

Introduction
Total joint arthroplasty patients are commonly Vitamin D insufficient (serum levels <30ng/mL), which is associated with increased risk of postoperative complications. This randomized controlled trial aims to determine if preoperative correction of hypovitaminosis D in TJA patients reduces postoperative complications.

Methods
Eligible TJA patients with serum vitamin D concentrations >30ng/mL formed the control group, and those with levels between 10–30ng/mL were randomized to low- or high-dose supplementation. Serum vitamin D levels were measured on the date of surgery for supplemented patients, and were followed up at 3 months. T-tests were used to compare differences between groups. Fisher’s exact test determined if there was a difference in emergency department visits between supplemented groups.

Results
Control patients presented with a mean preoperative Vitamin D level of 42.23 ng/mL±10.76. The low-dose supplementation group had a mean preoperative vitamin D of 21.67ng/mL±5.37 and a postoperative level of 33.8ng/mL±7.73. The high-dose supplementation group had a mean preoperative vitamin D level of 24.08ng/mL±4.54 and a postoperative level of 33.8ng/mL±11.52. There were no statistically significant differences in emergency department visits between cohorts (p=0.39).

Conclusion
Both Vitamin D supplementation regimens increased serum vitamin D to sufficient levels in low vitamin D patients with similar complications.

Clinical Implications
Patients who undergo total joint arthroplasty are commonly vitamin D insufficient, which is associated with increased risk of postoperative complications. Both vitamin D supplementation regimens in this study increased serum vitamin D to sufficient levels in low vitamin D patients.

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