Maier Gerrit Steffen, Horas Konstantin, Seeger Jörn Bengt, Roth Klaus Edgar, Kurth Andreas Alois, Maus Uwe
Department of Trauma Surgery, Justus-Liebig-University, Giessen, Germany,
Int Orthop. 2014 Jul;38(7):1499-504. doi: 10.1007/s00264-014-2338-6. Epub 2014 Apr 16.
Vitamin D is increasingly being recognized as an important mediator of immune function and may have a preventive role in the pathogenesis of periprosthetic joint infection. To the best of our knowledge, no other study has examined possible associations between periprosthetic joint infection and vitamin D deficiency. We investigated the rate of vitamin D deficiency in patients treated for periprosthetic joint infection and whether vitamin D deficiency is independent of other risk factors for vitamin D deficiency in patients with periprosthetic joint infection.
Serum 25-hydroxyvitamin D (25OHD) levels of every patient scheduled to receive a total prosthesis either of the hip, knee, or shoulder in the orthopaedic department of the Johannes-Guttenberg-University Hospital in Mainz, Germany (109 patients), were measured after admission. Furthermore, serum 25OHD levels were measured for every patient presenting with periprosthetic joint infection (n = 50) or aseptic loosening of the prosthesis (n = 31) scheduled to undergo revision surgery. The prevalence of normal (> 30 ng/ml), insufficient (20-30 ng/ml), and deficient (<20 ng/ml) 25OHD levels was determined.
All tested patient subgroups showed low vitamin D levels. Statistical analysis found no significant difference in vitamin D levels comparing patients with prosthesis and patients with aseptic prosthesis loosening (p = 0.58). Significant differences in 25OHD levels were found comparing patients with periprosthetic joint infection and patients scheduled for primary arthroplasty (p < 0.001). In addition, we found a significant difference (p < 0,001) in 25OHD levels of patients with periprosthetic joint infection compared with patients with aseptic prosthesis loosening.
We found a high frequency of vitamin D deficiency in patients being treated by primary arthroplasty and those with aseptic joint prosthetic loosening and periprosthetic joint infection. Vitamin D deficiency was severe in patients with periprosthetic joint infection.
维生素D日益被认为是免疫功能的重要调节因子，可能在假体周围关节感染的发病机制中起到预防作用。据我们所知，尚无其他研究探讨过假体周围关节感染与维生素D缺乏之间的可能关联。我们调查了接受假体周围关节感染治疗患者的维生素D缺乏率，以及假体周围关节感染患者中维生素D缺乏是否独立于其他维生素D缺乏风险因素。
在德国美因茨约翰内斯 - 古滕贝格大学医院骨科计划接受髋、膝或肩关节全假体置换的每位患者（109例）入院后测定血清25 - 羟基维生素D（25OHD）水平。此外，对计划接受翻修手术的出现假体周围关节感染（n = 50）或假体无菌性松动（n = 31）的每位患者测定血清25OHD水平。确定25OHD水平正常（> 30 ng/ml）、不足（20 - 30 ng/ml）和缺乏（<20 ng/ml）的患病率。
所有测试的患者亚组均显示维生素D水平较低。统计分析发现，比较假体患者和无菌性假体松动患者的维生素D水平无显著差异（p = 0.58）。比较假体周围关节感染患者和计划进行初次关节置换术的患者，发现25OHD水平有显著差异（p < 0.001）。此外，与无菌性假体松动患者相比，假体周围关节感染患者的25OHD水平有显著差异（p < 0.001）。
我们发现初次关节置换术治疗的患者、无菌性关节假体松动患者和假体周围关节感染患者中维生素D缺乏的频率较高。假体周围关节感染患者的维生素D缺乏情况严重。
