Vitamin D deficiency is increasingly recognized as a predictor of poorer outcomes in musculoskeletal diseases, affecting up to 1 in 4 individuals. Particularly in the context of total knee arthroplasty (TKA), where optimal recovery is crucial, understanding the role of vitamin D is essential. A recent study aimed to assess the impact of vitamin D supplementation on outcomes following primary total knee arthroplasty (TKA). The study was published in the JBJS Reviews. The study was conducted by Vivek K. and colleagues.
To comprehensively assess the relationship between vitamin D and TKA outcomes, a meticulous search across various databases was conducted. The selected studies underwent rigorous analysis, employing forest plots to visualize data dispersion and heterogeneity statistics to gauge consistency. Pooled effects were calculated with precise 95% confidence intervals and statistical significance set at a p-value < 0.05, ensuring robust findings.
The key findings of the study were:
• The analysis encompassed a total of 146,054 patients who underwent 150,107 total knee replacements (TKRs) across 10 studies meeting the inclusion criteria.
• Four out of 10 studies highlighted poorer functional outcome scores in patients with vitamin D deficiency, as assessed by measures such as the Western Ontario and McMaster Universities Osteoarthritis Index, Knee Society Scoring System, and American Knee Society scores.
• Vitamin D deficiency was associated with increased risks of revision surgery, joint infection, and postoperative stiffness.
• Meta-analysis revealed a significant increase in LOS among patients with vitamin D deficiency, with a standardized mean difference of -0.54 (95% CI: -0.69 to -0.38, p < 0.00001).
• Outcomes were improved with vitamin D supplementation in six out of 10 studies, indicating a potential benefit in mitigating the adverse effects associated with deficiency.
The findings underscore the importance of addressing vitamin D deficiency in patients undergoing TKA to optimize postoperative outcomes. Clinicians should consider screening for vitamin D levels preoperatively and implementing supplementation strategies as part of perioperative care protocols for TKA patients. Standardization of outcome measures will enhance comparability across studies and facilitate evidence-based decision-making in clinical practice.
Vitamin D deficiency is associated with poorer outcomes after primary TKA, but supplementation leads to improved outcomes. Further research is warranted to investigate the role of preoperative vitamin D screening and perioperative supplementation in TKA, and to standardize outcome measures for assessment.
Reference:
Vivek, K., Kamal, R., Perera, E., & Gupte, C. M. (2024). Vitamin D deficiency leads to poorer health outcomes and greater length of stay after total knee arthroplasty and supplementation improves outcomes: A systematic review and meta-analysis. JBJS Reviews, 12(4). https://doi.org/10.2106/jbjs.rvw.23.00150