Division of Human Nutrition, Wageningen University, Wageningen, the Netherlands.
Department of Physical Therapy, Gelderse Vallei Hospital, Ede, the Netherlands.
Ann Nutr Metab. 2018;73(3):252-260. doi: 10.1159/000492938. Epub 2018 Sep 25.
Insufficient serum vitamin D concentrations (50-75 nmol/L) are prevalent in 40-65% of patients who require total hip arthroplasty (THA). This could impair physical recovery after surgery. This study investigated the association between preoperative vitamin D status and physical performance after THA. Additionally, postoperative changes in vitamin D concentrations were measured.
We included 87 patients scheduled for elective THA and aged ≥65 years. Three groups were recruited: patients classified as vitamin D deficient (< 50 nmol/L, n = 23), insufficient (50-75 nmol/L, n = 32), or sufficient (> 75 nmol/L, n = 32). Serum 25-hydroxyvitamin D3 (25[OH]D3) concentration and physical performance were measured perioperatively. Linear mixed models were used to examine differences between groups.
Change in physical performance over time was not affected by preoperative vitamin D status. In contrast, for physical activity, both vitamin D (p = 0.021) and time (p < 0.001) effect was seen: from 80.2 ± 25.8 to 58.1 ± 17.8 min/day in the deficient group, 143.7 ± 19.8 to 92.9 ± 11.5 min/day in the insufficient group, and 108.1 ± 20.9 to 62.3 ± 12.9 min/day in the sufficient group. The Chair Stand Test, Timed Up and Go test, and 10-Meter Walking Test also improved significantly over time, but independent of vitamin D status. An increase in 25(OH)D3 concentration 6 weeks postoperatively was correlated with improved hip function (Pearson's r = -0.471, p = 0.018). Overall, serum 25(OH)D3 declined with 32% one day after surgery (p < 0.001), to nearly return to baseline values 6 weeks later in all groups.
Vitamin D status did not appear to affect physical recovery after THA. The drop in vitamin D after surgery deserves further investigation, but could possibly be explained by hemodilution.
需要全髋关节置换术（THA）的患者中，有 40-65%存在血清维生素 D 浓度不足（50-75nmol/L）。这可能会影响术后的身体恢复。本研究调查了术前维生素 D 状态与 THA 后身体表现之间的关系。此外，还测量了术后维生素 D 浓度的变化。
我们纳入了 87 名计划接受择期 THA 且年龄≥65 岁的患者。招募了三组患者：维生素 D 缺乏组（<50nmol/L，n=23）、不足组（50-75nmol/L，n=32）和充足组（>75nmol/L，n=32）。在围手术期测量血清 25-羟维生素 D3（25[OH]D3）浓度和身体表现。使用线性混合模型来检验组间差异。
术前维生素 D 状态并不影响身体表现的随时间变化。相比之下，对于体力活动，维生素 D（p=0.021）和时间（p<0.001）都有影响：在维生素 D 缺乏组中，从 80.2±25.8 分钟/天降至 58.1±17.8 分钟/天，在不足组中，从 143.7±19.8 分钟/天降至 92.9±11.5 分钟/天，在充足组中，从 108.1±20.9 分钟/天降至 62.3±12.9 分钟/天。坐立起身测试、计时起立行走测试和 10 米步行测试也随时间显著改善，但与维生素 D 状态无关。术后 6 周时 25（OH）D3 浓度的增加与髋关节功能的改善相关（Pearson r=-0.471，p=0.018）。总体而言，术后一天血清 25（OH）D3 下降 32%（p<0.001），所有组在 6 周后几乎恢复到基线值。
维生素 D 状态似乎不会影响 THA 后的身体恢复。术后维生素 D 下降值得进一步研究，但可能可以通过血液稀释来解释。
