Department of Orthopaedics, Trauma and Plastic Surgery, University Hospital Leipzig, Leipzig, Germany,
ZESBO - Zentrum zur Erforschung der Stuetz- und Bewegungsorgane, Leipzig, Germany,
Clin Interv Aging. 2018 Aug 17;13:1429-1435. doi: 10.2147/CIA.S171307. eCollection 2018.
The importance of the vitamin D homeostasis in infections is already known. However, its significance in periprosthetic infections (PPIs) after total hip arthroplasty and total knee arthroplasty is largely unexplored. The aim of the study is to precisely analyze the vitamin D balance in patients with PPIs after total hip arthroplasty and total knee arthroplasty. Here, cases with primary endoprosthesis implants and aseptic loosening are used as comparison groups.
In this prospective matched-pair analysis, patients with PPI at the hip and knee joints were included in the study group (SG). The control groups (CGs) consisted of patients with primary implants (CG I) and who underwent replacement surgery due to aseptic loosening (CG II). In addition to 25 OH vitamin D3 and calcium, bone mineral and protein parameters were determined. An osteoporosis-specific questionnaire was collected.
There are no significant differences in the 25 OH-vitamin D levels between the SG (17.9±8.9) and both CGs (CG I: 16.8±6.90; CG II: 19.7±7.90). However, compared with the SG, significantly higher levels of calcium (Ca) and bone-specific alkaline phosphatase were found in both CGs in comparison with the SG. Significantly lower values concerning the protein balance in PPI were conspicuous. Acute PPI showed a significant reduction in 25 OH vitamin D3 compared with chronic infections (8.3±5.98 vs 21.6±8.40, =0.002). Calcium and protein balance were also significantly reduced in acute PPIs.
Acute PPIs of the hip and knee joints show a significantly reduced calcium and 25 OH vitamin D3 levels as well as lowered proteins (albumin and total protein) compared with chronic infections as well as primary endoprostheses and aseptic replacement operations. Substitution of vitamin D3 and calcium with simultaneous adaptation of the protein balance is recommended in all PPIs, especially in the acute PPI.
维生素 D 体内平衡在感染中的重要性已为人所知。然而，其在全髋关节置换术和全膝关节置换术后假体周围感染（PPIs）中的意义在很大程度上尚未得到探索。本研究旨在精确分析全髋关节置换术和全膝关节置换术后 PPI 患者的维生素 D 平衡。在这里，将原发性假体植入物和无菌性松动的病例用作对照。
在这项前瞻性配对分析中，将髋关节和膝关节 PPI 患者纳入研究组（SG）。对照组（CG）由原发性植入物患者（CG I）和因无菌性松动而接受翻修手术的患者（CG II）组成。除了 25-羟维生素 D3 和钙之外，还测定了骨矿物质和蛋白质参数。收集了骨质疏松症特定的问卷。
SG（17.9±8.9）与 CGs（CG I：16.8±6.90；CG II：19.7±7.90）之间的 25-羟维生素 D 水平没有显着差异。然而，与 SG 相比，CG 中的钙（Ca）和骨特异性碱性磷酸酶水平明显更高。在 PPI 中，蛋白质平衡明显降低的情况明显。急性 PPI 与慢性感染相比，25-羟维生素 D3 明显减少（8.3±5.98 对 21.6±8.40，=0.002）。急性 PPI 中的钙和蛋白质平衡也明显降低。
与慢性感染以及原发性假体和无菌性置换手术相比，髋关节和膝关节的急性 PPI 显示出明显降低的钙和 25-羟维生素 D3 水平以及降低的蛋白质（白蛋白和总蛋白）。建议在所有 PPI 中，尤其是在急性 PPI 中，补充维生素 D3 和钙，并同时适应蛋白质平衡。
