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Vitamin D Insufficiency in Patients With THA: Prevalence and Effects on Outcome

  • Symposium: 2013 Hip Society Proceedings
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

The consequences of vitamin D insufficiency in the elderly remain controversial. The prevalence and potential effects of its chronic insufficiency on quality of life and physical function in patients undergoing THA have received little attention.

Question/purposes

We determined (1) prevalence of preoperative vitamin D insufficiency in patients undergoing THA and (2) relationships of insufficiency to patient-perceived outcomes (PPOs) and hip scores.

Methods

We retrospectively reviewed 62 consecutive patients who underwent 66 primary THAs. We excluded two patients with missing data and the second hip of bilateral THAs, leaving 60 patients (60 hips) for final inclusion. Based on preoperative plasma 25-hydroxyvitamin-D3 levels, patients were retrospectively assigned into a normal or insufficient group. We used two different thresholds (20 and 30 ng/mL) to define insufficiency; groups were set twice. We compared demographics, BMI, American Society of Anesthesiologists score, Charlson Comorbidity Index; albumin, transferrin, calcium levels; and total lymphocyte count between groups. The insufficient group had a higher mean BMI with the 20-ng/mL cutoff but not with the 30-ng/mL cutoff. We compared the 20-ng/mL cutoff groups (adjusting for BMI) and the 30-ng/mL cutoff groups in terms of preoperative and postoperative Quality of Well-being Scale, SF-36, WOMAC, Harris hip, and Merle d’Aubigné-Postel scores. Mean followup was 11 months (range, 3–24 months).

Results

The prevalence of vitamin D insufficiency was 30% (using 20 ng/mL) and 65% (using 30 ng/mL). Preoperative and postoperative Harris hip and Merle d’Aubigné-Postel scores were lower in patients with insufficiency using 30 ng/mL. No differences in PPOs or hip scores were found using 20 ng/mL.

Conclusions

Hypovitaminosis D was common in patients with THA and associated with lower hip scores. Standardization of the definition of hypovitaminosis D is urgently needed so that further studies can properly evaluate its real prevalence, potential negative effects on function, and therapeutic effects of reversing insufficiency before THA.

Level of Evidence

Level III, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.

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Acknowledgments

The authors thank Rene O. Guedes De Las Casas MD for his technical support.

Author information

Authors and Affiliations

  1. Orthopaedic Institute at Mercy Hospital, 3659 S Miami Avenue, Suite 4008, Miami, FL, 33133, USA

    Carlos J. Lavernia MD

  2. Arthritis Surgery Research Foundation and The Orthopaedic Institute at Mercy Hospital, Miami, FL, USA

    Jesus M. Villa MD & David A. Iacobelli MD

  3. Florida International University, 11200 SW 8th Street, Miami, FL, USA

    Mark D. Rossi PhD

Authors
  1. Carlos J. Lavernia MD
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  2. Jesus M. Villa MD
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  3. David A. Iacobelli MD
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  4. Mark D. Rossi PhD
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Corresponding author

Correspondence to Carlos J. Lavernia MD.

Additional information

Each author certifies that he or she, or a member of his or her immediate family, has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

One of the authors (CJL) certifies that he has received or may receive payments or benefits, during the study period, an amount of USD 10,000 to USD 100,000 from Mako Surgical Corp (Fort Lauderdale, FL, USA), an amount of USD 10,000 to USD 100,000 from Johnson & Johnson (New Brunswick, NJ, USA), an amount of USD 10,000 to USD 100,000 from Zimmer Inc (Warsaw, IN, USA), an amount of USD 10,000 to USD 100,000 from Wright Technologies Inc (Arlington, TN, USA), and an amount of USD 10,000 to USD 100,000 from Symmetry Medical Inc. (Warsaw, IN, USA).

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

This work was performed at the Orthopaedic Institute at Mercy Hospital, Miami, FL, USA.

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Lavernia, C.J., Villa, J.M., Iacobelli, D.A. et al. Vitamin D Insufficiency in Patients With THA: Prevalence and Effects on Outcome. Clin Orthop Relat Res 472, 681–686 (2014). https://doi.org/10.1007/s11999-013-3172-7

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  • DOI: https://doi.org/10.1007/s11999-013-3172-7

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