Effect of Vitamin D Deficiency on Periprosthetic Joint Infection and Complications after Primary Total Joint Arthroplasty

Murat Birinci; Ömer Serdar Hakyemez; Muhammed Ali Geçkalan; Müren Mutlu; Fatih Yildiz; Ömer Faruk Bilgen; İbrahim Azboy

doi:10.1016/j.arth.2024.05.012

Effect of Vitamin D Deficiency on Periprosthetic Joint Infection and Complications after Primary Total Joint Arthroplasty

J Arthroplasty. 2024 May 9:S0883-5403(24)00445-5. doi: 10.1016/j.arth.2024.05.012. Online ahead of print.

Authors

Murat Birinci¹, Ömer Serdar Hakyemez², Muhammed Ali Geçkalan³, Müren Mutlu⁴, Fatih Yildiz², Ömer Faruk Bilgen⁴, İbrahim Azboy⁵

Affiliations

¹ İstanbul Medipol University, Faculty of Medicine, Department of Orthopaedics and Traumatology, İstanbul, Türkiye. Electronic address: drmuratbirinci@gmail.com.
² İstanbul Medipol University, Faculty of Medicine, Department of Orthopaedics and Traumatology, İstanbul, Türkiye.
³ İstanbul Bezmialem University, Faculty of Medicine, Department of Orthopaedics and Traumatology, İstanbul, Türkiye.
⁴ Medicabil Hospital, Department of Orthopaedics and Traumatology, Bursa, Türkiye.
⁵ İstanbul Medipol University, School of Medicine, Department of Orthopaedics and Traumatology, İstanbul, Türkiye.

PMID: 38734328
DOI: 10.1016/j.arth.2024.05.012

Abstract

Introduction: Vitamin D deficiency is a global problem, and 13 to 75% of patients undergoing total joint arthroplasty (TJA) have vitamin D deficiency. Several studies have shown that low preoperative vitamin D levels may increase the risk of postoperative complications, including periprosthetic joint infection (PJI), in patients undergoing primary TJA. However, most of the studies are underpowered. This study aimed to investigate the relationship between vitamin D deficiency and surgical and medical complications after primary TJA, with a specific focus on PJI.

Methods: Prospectively collected institutional multicenter arthroplasty databases were reviewed to identify patients who underwent primary total knee and hip arthroplasty between 2019 and 2022. The study group was defined as patients whose vitamin D level is < 30 ng/dl and who received a single oral dose of 7.5 mg (300,000 IU) D3 within two weeks before index surgery (n = 488; mean age 63 years). Patients in the control group were those whose preoperative vitamin D levels were unknown and who did not receive vitamin D supplementation (n = 592, mean age 66). Demographics, comorbidities, and 90-day postoperative surgical and medical complications were recorded. The groups were compared regarding 90-day medical and surgical complications, including PJI, mortality, and readmission rates.

Results: The total number of complications (8.6 and 4.3%; respectively; P = 0.005), superficial wound infection (2.5 and 0.2%, respectively; P < 0.001), and postoperative cellulitis (2.2 and 0% respectively; P < 0.001) were statistically significantly higher in the patient group who did not receive vitamin D supplementation. However, 90-day mortality (P = 0.524), PJI (P = 0.23), and readmission rate (P = 0.683) were similar between the groups.

Conclusion: This study demonstrated that preoperative optimization of vitamin D levels may be beneficial in reducing postoperative complications, including superficial wound infection and postoperative cellulitis. Administering an oral 300,000 U single-dose vitamin D regimen to correct vitamin D deficiency can positively impact outcomes following primary TJA.

Keywords: D vitamin; deficiency; periprosthetic joint infection; superficial wound problems; supplementation.