Department of Orthopaedics, Lilavati Hospital and Research Centre, Mumbai, India.
Department of Orthopaedics, Breach Candy Hospital Trust, Mumbai, India.
Clin Orthop Surg. 2021 Sep;13(3):336-343. doi: 10.4055/cios20147. Epub 2021 Mar 9.
It has been widely reported that vitamin D (vit D) affects preoperative, postoperative, and long-term outcomes after total knee arthroplasty (TKA). Our aim was to study vit D trajectory after TKA and compare effects of oral versus intramuscular (IM) supplementation in insufficient patients and assess its effects on immediate functional recovery in the first 2 weeks after TKA.
Vit D levels < 30 ng/mL are considered insufficient. We prospectively enrolled 60 patients (20 per group): group I, vit D sufficient patients; group II, vit D insufficient patients given IM supplementation (cholecalciferol 6,00,000 IU); and group III, vit D insufficient patients given oral supplementation (cholecalciferol 600,000 IU). Vit D levels, knee flexion, Timed Up and Go (TUG) test results, and visual analog scale (VAS) score were recorded preoperatively and postoperatively on day 3 and 14.
In group I, mean preoperative vit D significantly dropped at postoperative day (POD) 3 and POD 14 ( = 0.001). In group II, mean preoperative vit D rose at POD 3 and rose significantly at POD 14 ( = 0.001). In group III, mean preoperative vit D increased significantly at both POD 3 and POD 14 ( < 0.001). Also, in group III, the rise in vit D was significantly higher than that in group II both at POD 3 and POD 14 ( < 0.05). In group III, 19 of 20 insufficient patients became sufficient on POD 3 and all 20 by POD 14. In group II, even by POD 14, only 11 of 20 insufficient patients became sufficient. Functional parameters (flexion, change in flexion, TUG test results, and VAS score) were comparable ( > 0.05) in all groups. Changes in TUG test showed a significant increase in group II (48.5 seconds) when compared to group I (35.5 seconds) at POD 3 ( < 0.05), suggesting a slower recovery. It remained comparable ( > 0.05) between group III and group I.
We found that vit D insufficient patients can be rapidly supplemented on the morning of surgery with a large dose of oral cholecalciferol 600,000 IU, and the effect was consistent over 2 weeks after surgery. Orally supplemented vit D insufficient patients also showed functional recovery comparable to vit D sufficient patients. IM supplementation increased vit D levels only at 2 weeks and the rise was significantly lower than oral supplementation. Interestingly, approximately 25% of vit D sufficient patients who were not supplemented after TKA became insufficient in the first 2 weeks postoperatively.
维生素 D（vit D）对全膝关节置换术（TKA）术前、术后和长期结果的影响已被广泛报道。我们的目的是研究 TKA 后 vit D 轨迹，并比较口服与肌肉内（IM）补充在不足患者中的效果，评估其对 TKA 后 2 周内即时功能恢复的影响。
vit D 水平<30ng/mL 被认为是不足的。我们前瞻性纳入 60 例患者（每组 20 例）：I 组，vit D 充足患者；II 组，vit D 不足患者给予 IM 补充（胆钙化醇 600000IU）；III 组，vit D 不足患者给予口服补充（胆钙化醇 600000IU）。记录术前和术后第 3 天和第 14 天的 vit D 水平、膝关节屈曲度、计时起立行走测试（TUG）结果和视觉模拟评分（VAS）。
I 组中，术前 vit D 均值在术后第 3 天（POD3）和第 14 天（POD14）显著下降（=0.001）。II 组中，术前 vit D 均值在 POD3 升高，在 POD14 显著升高（=0.001）。III 组中，术前 vit D 均值在 POD3 和 POD14 均显著升高（<0.001）。此外，在 POD3 和 POD14，III 组 vit D 的升高明显高于 II 组（<0.05）。在 III 组中，20 例不足患者中有 19 例在 POD3 时变为充足，所有患者在 POD14 时均变为充足。在 II 组中，即使在 POD14，也只有 11 例不足患者变为充足。所有组的功能参数（屈曲度、屈曲度变化、TUG 测试结果和 VAS 评分）均相似（>0.05）。与 I 组（35.5 秒）相比，II 组（48.5 秒）在 POD3 时 TUG 测试的变化显著增加（<0.05），提示恢复较慢。III 组与 I 组之间的差异无统计学意义（>0.05）。
我们发现，vit D 不足患者可在手术当天早上经口服给予大剂量胆钙化醇 600000IU 快速补充，且术后 2 周内效果一致。口服补充 vit D 不足的患者也表现出与 vit D 充足患者相似的功能恢复。IM 补充仅在 2 周时增加 vit D 水平，且升高幅度明显低于口服补充。有趣的是，大约 25%的 TKA 后未补充 vit D 的 vit D 充足患者在术后前 2 周内变为不足。
