Low pre-operative vitamin D associated with lower baseline PROMs but greater improvement following total joint arthroplasty

Abstract

Aims and objectives

This study investigated whether low pre-operative 25-OH-vitamin-D (25(OH)D) is associated with worse patient-reported outcome measures (PROMs) and higher odds of post-operative complications following TJA in a diverse population.

Materials & methods

This was a retrospective study of patients undergoing total hip (THA) or knee arthroplasty (TKA) at an urban tertiary care center between 2020 and 2023. A total of 488 patients were included, representing 538 surgeries. Patients identified as 25(OH)D deficient (<12 nmol/L) or insufficient (12–30 nmol/L) were prescribed supplementation before or at the time of surgery per institution protocol. We analyzed the relationship between 25(OH)D level and Hip dysfunction and Osteoarthritis Outcome Score for Joint Replacement (HOOS, JR) or Knee injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS, JR) pre-operatively, at 6 weeks, and at 90-days post-surgery, as well as 90-day complications.

Results

Low pre-operative 25(OH)D was observed in 46.5% of surgeries and was associated with lower pre-operative HOOS, JR score (P = 0.002). Improvement in HOOS, JR score at 90-days post-operatively was significantly greater in the 25(OH)D deficient group (P = 0.043). No statistical difference was found among KOOS, JR scores. Low pre-operative 25(OH)D did not increase odds of re-operation (P = 0.484), readmission (P = 0.385), wound complications (P = 0.595), or overall complications (P = 0.656).

Conclusion

Our results suggest that low 25(OH)D is associated with lower pre-operative HOOS, JR score and greater improvement in HOOS, JR score following THA; similar trends were appreciated in TKA but were not significant. TJA coupled with 25(OH)D supplementation in patients who have low 25(OH)D may result in similar post-operative outcomes as those with normal pre-operative 25(OH)D.