The Majority of Total Joint Arthroplasty Patients Have Hypovitaminosis D: An Analysis from a Single Tertiary-Care Center in China.

Abstract

Hypovitaminosis D is common in total joint arthroplasty (TJA) patients and potentially contributes to elevated risks of postoperative complications, such as diminished functional scores, elevated postoperative pain levels, prolonged hospitalization, increased risks of superficial surgical site infections, and postoperative cellulitis. Despite this, little is known about the prevalence of hypovitaminosis D in patients undergoing TJA. Therefore, we sought to investigate the prevalence of hypovitaminosis D, pre-hospital screening rates, and rates of hypovitaminosis D treatment in the TJA population. This was an analysis of prospectively collected data from 384 consecutive Han Chinese patients (244 women, 140 men; mean age 64 years [range, 23 to 99]) who underwent elective TJA at a single tertiary-care center. Charts were reviewed for patient demographics, pre-hospital vitamin D testing, and treatment with vitamin D supplements. Serum vitamin D levels were measured in all patients the day before surgery. Vitamin D status was categorized as deficiency (< 20 ng/mL), insufficiency (20 to 29 ng/mL), and sufficiency (≥ 30 ng/mL). Of the 384 patients, none had measured serum vitamin D levels before hospitalization, while only 2.6% (10 of 384) received vitamin D supplementation as adjunctive osteoporosis therapy, with four cases in total hip arthroplasty (THA) and six in total knee arthroplasty (TKA) cohorts. Among the 384 patients, the mean 25(OH)D level was 24.1 ± 8.5 ng/mL, with 76.3% (293 of 384) exhibiting hypovitaminosis D (deficiency: 33.6%, insufficiency: 42.7%). The mean 25(OH)D levels were 24.2 ± 9.5 ng/mL in THA patients and 24.1 ± 7.8 ng/mL in TKA patients. Subgroup analysis revealed vitamin D deficiency in 35.7% (55 of 154) of THA patients and 32.2% (74 of 230) of TKA patients, while insufficiency rates were 35.1% (54 of 154) and 47.8% (110 of 230), respectively. Hypovitaminosis D was highly prevalent (76.3%) in patients awaiting TJA, but the rates of diagnosis and pharmacologic hypovitaminosis D treatment were very low. Therefore, more attention is needed to evaluate and treat hypovitaminosis D in patients awaiting TJA.