Vitamin D Deficiency Leads to Poorer Health Outcomes and Greater Length of Stay After Total Knee Arthroplasty and Supplementation Improves Outcomes: A Systematic Review and Meta-Analysis.
Level 2 - randomized trial
Systematic review and meta-analysis of mixed observational and interventional studies
PubMed 38574186 · doi:10.2106/JBJS.RVW.23.00150
What was done
A systematic review and meta-analysis searched PubMed, Cochrane CENTRAL, ClinicalTrials.gov, AAOS, and British Orthopaedic Association databases to evaluate how vitamin D deficiency and supplementation influence clinical and functional outcomes following primary total knee arthroplasty (TKA). Heterogeneity (I²) and pooled effect sizes with 95% confidence intervals were calculated where data permitted.
What was found
Ten studies evaluating 146,054 patients (150,107 knees) were included, of which 3 were suitable for quantitative meta-analysis. Vitamin D deficiency was associated with a significant increase in hospital length of stay (standardized mean difference -0.54, 95% CI -0.69 to -0.38, p < 0.00001). Four studies linked deficiency to poorer functional scores (WOMAC, Knee Society Score, American Knee Society Score), higher revision rates, increased joint infection incidence, and postoperative stiffness. Six of 10 studies reported improved outcomes with vitamin D supplementation.
Why it matters
Vitamin D deficiency is a potentially modifiable risk factor in orthopedic surgery that correlates with prolonged hospitalization and inferior recovery after primary knee replacement.
Limits
Only 3 of the 10 included studies could be quantitatively meta-analyzed, and pooled numerical estimates were restricted to length of stay. The abstract does not specify the study designs (randomized versus observational cohorts), definitions or cutoffs used for vitamin D deficiency, or the dosing and duration of supplementation regimens.
Cited by
- context Taking 50,000 IUs of vitamin D3 with magnesium and K2 for 3 days before any surgical procedure greatly improves outcomes.