Brambilla Lorenzo, Peretti Giuseppe Maria, Sirtori Paolo, Maffulli Nicola, Mangiavini Laura
Residency Program in Orthopaedics and Traumatology, University of Milan, Via Festa del Perdono, 7, 20122 Milan, Italy.
University Equipe of Regenerative and Reconstructive Orthopaedics (EUORR), IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi, 4, 20161 Milan, Italy.
Br Med Bull. 2020 Oct 14;135(1):50-61. doi: 10.1093/bmb/ldaa018.
Low levels of vitamin D are common in patients undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA), but it is still unclear whether the outcome of such surgery is related to vitamin D levels.
Publicly available electronic databases were systematically reviewed to update knowledge about the role of vitamin D in THA and TKA patients, and to appraise the correlation between vitamin D levels before surgery and post-surgical outcomes. Eight studies were included in our review: six employed prospective observational designs, two reported retrospective database interrogations. Six prospective observational studies and two retrospective database interrogations matched inclusion and exclusion criteria.
Patients undergoing THA and TKA have a high prevalence of hypovitaminosis D. Five of eight studies (62.5%) report a statistically significant association between low vitamin D status and worse outcomes after THA and TKA.
Different explanations have been proposed for vitamin D insufficiency, but some authors have questioned the correctness of the methods used to measure the vitamin D levels.
A trial focusing on the role of vitamin D supplementation on safety and outcomes of patients undergoing THA and TKA with low vitamin D status is ongoing.
Further studies should explore the possible causal relationship between vitamin D status and outcomes of THA and TKA and verify the laboratory methods to analyse it.
全髋关节置换术（THA）和全膝关节置换术（TKA）患者中维生素D水平较低的情况很常见，但此类手术的结果是否与维生素D水平相关仍不清楚。
对公开可用的电子数据库进行了系统回顾，以更新关于维生素D在THA和TKA患者中的作用的知识，并评估术前维生素D水平与术后结果之间的相关性。我们的综述纳入了八项研究：六项采用前瞻性观察设计，两项报告了回顾性数据库查询。六项前瞻性观察研究和两项回顾性数据库查询符合纳入和排除标准。
接受THA和TKA的患者维生素D缺乏症的患病率很高。八项研究中有五项（62.5%）报告维生素D水平低与THA和TKA术后较差结果之间存在统计学上的显著关联。
对于维生素D不足提出了不同的解释，但一些作者质疑用于测量维生素D水平的方法的正确性。
一项关注维生素D补充剂对维生素D水平低的THA和TKA患者安全性和结果的作用的试验正在进行中。
进一步的研究应探索维生素D状态与THA和TKA结果之间可能的因果关系，并验证分析它的实验室方法。
