Vitamin D is crucial for ideal bone health and good muscle function, both essential requirements for successful joint arthroplasty. Hence, vitamin D deficiency has recently been identified as a predictor of poorer outcomes in patients scheduled to undergo total joint arthroplasty (TJA). Moreover, there is ample evidence today that vitamin D deficiency is associated with periprosthetic joint infection. Yet, vitamin D deficiency seems to be frequent in patients who are scheduled to undergo TJA. However, the prevalence of hypovitaminosis D in patients who require revision arthroplasty (rTJA) is largely unknown. Further, risk factors of vitamin D deficiency in these patients remain to be elucidated. For this reason, the primary objective of this study was to assess the vitamin D status of patients scheduled to undergo rTJA of the hip, knee and shoulder. The secondary objective was to identify potential risk factors for hypovitaminosis D in these patients. Serum vitamin D [25(OH)D] levels of 249 patients who were scheduled for rTJA were assessed over a period of twelve months at a high-volume TJA centre. Collectively, 23% of patients reported a routine intake of vitamin D supplements (58/249). Notably, 81% of patients (155/191) who did not report a routine vitamin D intake presented with insufficient vitamin D levels (below 30 ng/mL), while only 19% of patients (36/191) had sufficient vitamin D levels. Of those who reported a routine vitamin D intake, 75% (43/58) had sufficient vitamin D levels, while 25% (15/58) showed insufficient vitamin D status. Patients who did not routinely take any vitamin D supplements had significantly lower vitamin D levels compared to patients who reported regular vitamin D intake (19.91 ng/mL vs. 40.66 ng/mL). Further, BMI and nicotine abuse were identified as potential risk factors for hypovitaminosis D in patients without vitamin D supplementation. Moreover, the season of spring seems to be a risk factor in patients with vitamin D supplementation, while age itself did not appear to be a significant risk factor for low vitamin D levels. In conclusion, we found an alarmingly high rate of vitamin D deficiency in patients scheduled to undergo rTJA. Notably, reported routine vitamin D supplementation showed significantly increased serum vitamin D levels compared to patients with no reported supplementation. Due to the high prevalence of vitamin D deficiency, we believe that vitamin D status should routinely be assessed in patients who are scheduled to undergo rTJA.

Background: Vitamin D deficiency represents a global health problem of enormous extent. It is estimated that around one billion people worldwide have inadequate vitamin D levels. This phenomenon is directly associated with negative impact on a variety of orthopaedic conditions. Further, there is now robust evidence that perioperative vitamin D levels in patients scheduled for total joint replacement (TJA) affect outcome and the healing process. To date, only few studies focus on vitamin D levels of patients scheduled for total arthroplasty of the upper extremity (shoulder and elbow). For this reason, the objective of this study is to determine the prevalence of vitamin D deficiency in this patient collective. Methods: In a monocentric cohort study, serum levels of 25-hydroxyvitamin D (25OHD) were measured preoperatively in all patients undergoing total shoulder or elbow arthroplasty. Demographic and perioperative data as well as comorbidities were recorded from medical records to assess for potential risk factors for hypovitaminosis D. Multivariate regression analyses were used to identify risk factors for vitamin D insufficiency and deficiency. Results: Collectively, 108 patients with total joint replacement of the upper extremity were included over a period of twelve months. Notably, 28.7% (31/108) of patients reported a regular intake of vitamin D supplements. 62.3% (19/31) of those had sufficient vitamin D levels, while 38.7% (12/31) had insufficient and further 6% (2/31) deficient vitamin D levels (<20 ng/mL). Remarkably, 87% of patients that did not report a regular vitamin D intake (n = 77) showed low serum vitamin D levels. In particular, 63.6% (49/77) were vitamin D deficient, 23.4% (18/77) vitamin D insufficient and only 13% of patients had vitamin D serum levels above or equal to 30 ng/mL that are considered sufficient (mean serum 25(OH)D = 36.4 ng/mL for vitamin D substitution vs. 18.4 ng/mL for no substitution; p < 0.0001). Moreover, vitamin D levels varied between seasons, with the lowest levels recorded in spring (OR = 4.32, p = 0.044) and the highest levels in summer (p = 0.005 vs. spring). Conclusion: Patients undergoing total shoulder or elbow arthroplasty have an increased risk profile for hypovitaminosis D (vitamin D supplementation had 94% lower odds of being deficient; OR = 0.06, p = 0.001). Seasonal circumstances at the point of arthroplasty seem to be a key risk factor for low vitamin D levels. For this reason, it would be advisable to consider preoperative serum vitamin D level measurement as an integral part of the regularly performed preoperative care.

Einleitung: Vitamin D-Mangelerscheinungen stellen ein weltweites Gesundheitsproblem von enormem Ausmaß dar. Mehrere Studien konnten zeigen, dass erniedrigte Vitamin D-Spiegel auch innerhalb des orthopädischen Patientenkollektivs in Deutschland omnipräsent sind. Diese Erscheinung ist direkt mit negativen Einflüssen auf eine Vielzahl orthopädischer Krankheitsbilder assoziiert. Ziel dieser Studie ist es, die Prävalenz des Vitamin D-Mangels für die endoprothetische Patientengruppe in Deutschland auf Basis einer großen Kohorte zu erfassen. Darüber hinaus sollen es die Untersuchungen ermöglichen, Risikopatienten für einen Vitamin D-Mangel entsprechend zu identifizieren. Methode: Serumspiegel von 25-Hydroxyvitamin D (25OHD) wurden bei allen Patienten mit geplanter endoprothetischer Versorgung (Hüfte, Knie oder Schulter) präoperativ gemessen. Eingeschlossen wurden sowohl Patientengruppen mit endoprothetischer Primärimplantation als auch mit geplanten endoprothetischen Wechseleingriffen (Revisionseingriffe). Demographische und perioperative Daten sowie Begleiterkrankungen wurden aus den Krankenakten erfasst. Die Prävalenz von ausreichendem (≥ 30 ng/ml), insuffizientem (20–29 ng/ml) und defizientem (<20 ng/ml) Vitamin D-Spiegel in diesem Patientenkollektiv wurde bestimmt. Ergebnisse: Innerhalb von 6 Monaten wurden 541 Patienten eingeschlossen. 76 % der eingeschlossenen Patienten [Totale Anzahl mit Mangel N = 193, Totale Anzahl mit Insuffizienz N= 222] zeigten präoperativ erniedrigte Serumspiegel von Vitamin-D. In der Kohorte mit geplanter Prothesenimplantation der Schulter zeigt sich anteilig die höchste Vitamin D-Mangelversorgung (Schulter-TEP = 95%, Knie-TEP= 76%, Hüft-TEP = 76%). Auch ergaben sich signifikante Unterschiede der mittleren Vitamin D-Spiegel in der Differenzierung nach Primär- und Revisionseingriffen (Primär = 23,2 ng/ml, Revision = 21,1 ng/ml, p= 0,02). Bei Wechseleingriffe aufgrund periprothetischer Infektionen war nur in 15 % der versorgten Patienten ein ausreichender Vitamin D-Spiegel präoperativ zu finden (55% defizient, 30% insuffizient). Deutlich erniedrigte Vitamin D-Spiegel waren auch bei Patienten mit einem BMI über 40, hohem Alter (>80) und bei Rauchern zu finden. Diskussion: Die Prävalenz von Vitamin D-Mangel ist in der endoprothetischen Patientengruppe hoch. Patienten mit geplanter Prothesenimplantation der Schulter sowie vor geplanten Revisionseingriffe der großen Gelenke weißen ein erhöhtes Risikoprofil für präoperativ erniedrigte Vitamin D-Spiegel auf. Des Weiteren ist ein regelmäßiger Nikotinabusus, höheres Patientenalter (> 80 Jahre) und Adipositas (≥ Adipositas Grad 3) häufiger mit Vitamin D-Mangel assoziiert. Keywords: Endoprothetik, Vitamin D Mangel: Prävalenz, Vitamin D Mangel: Risikofaktoren Korrespondenzadresse: Miledi Hoxha, König Ludwig Haus Würzburg, Orthopädie, Friedenstraße 2, 97072 Würzburg, Deutschland, E-Mail: miledihoxha@gmail.com Article published online: 13 March 2024 © 2024. Thieme. All rights reserved. Georg Thieme Verlag Rüdigerstraße 14, 70469 Stuttgart, Germany