Heinz Tizian, Hoxha Miledi, Anderson Philip Mark, Jakuscheit Axel, Weißenberger Manuel, Lüdemann Martin, Rak Dominik, Rudert Maximilian, Horas Konstantin
Department of Orthopaedic Surgery, University of Wuerzburg, Koenig-Ludwig-Haus, Brettreichstr 11, 97074 Wuerzburg, Germany.
Frankfurt Centre for Bone Health and Endocrinology, 60313 Frankfurt, Germany.
Nutrients. 2024 Nov 21;16(23):3991. doi: 10.3390/nu16233991.
Several studies have reported a high prevalence of hypovitaminosis D in orthopedic patients. The purpose of this prospective observational study was to report on the prevalence of hypovitaminosis D in patients scheduled for elective primary total knee arthroplasty (TKA) and its associated risk factors.
In this monocentric cohort study, 25(OH) vitamin D serum levels were measured in 687 consecutive patients undergoing primary total knee arthroplasty (TKA) over a period of twelve months. Vitamin D levels were classified into deficiency (<20 ng/mL), insufficiency (20-29 ng/mL), and sufficiency (≥30 ng/mL). The study assessed the association of vitamin D levels with demographic and clinical factors, including age, sex, BMI, smoking status, and season of measurement. Statistical analyses included chi-square tests, correlation analyses, and multiple linear regression to identify significant predictors of vitamin D levels.
The cohort had a mean age of 67.70 ± 8.95 years and a mean BMI of 31.00 ± 5.71 kg/m. Collectively, 33.9% of patients were vitamin D deficient, a further 32.9% were insufficient, and only 33.2% were sufficient. Vitamin D levels varied significantly with the season and were associated with obesity and smoking. Specifically, there was a small significant inverse correlation between BMI and vitamin D levels (r = -0.17, < 0.01). Furthermore, regular nicotine abuse was linked to lower vitamin D levels (r = 0.14, < 0.01). Multiple linear regression analysis reveals that age, BMI, nicotine abuse, and season were small significant predictors of preoperative vitamin D levels (R = 0.15, adjusted R = 0.12). A total of 121 (17.61%) patients reported routine vitamin D intake prior to surgery. Supplementing patients had a significantly higher mean serum vitamin D level and a significant reduction in the mean length of in-hospital stay ( < 0.01).
The prevalence of vitamin D insufficiency and deficiency in patients undergoing elective primary TKA is alarmingly high. In ongoing efforts to optimize the efficacy and outcome of the TKA procedure, orthopedic surgeons should be advised to strongly implement the role of perioperative vitamin D levels in their routine practice.
多项研究报告称骨科患者维生素D缺乏症的患病率很高。这项前瞻性观察性研究的目的是报告择期初次全膝关节置换术（TKA）患者维生素D缺乏症的患病率及其相关危险因素。
在这项单中心队列研究中，对连续687例在12个月内接受初次全膝关节置换术（TKA）的患者测量了血清25（OH）维生素D水平。维生素D水平分为缺乏（<20 ng/mL）、不足（20 - 29 ng/mL）和充足（≥30 ng/mL）。该研究评估了维生素D水平与人口统计学和临床因素的关联，包括年龄、性别、体重指数（BMI）、吸烟状况和测量季节。统计分析包括卡方检验、相关性分析和多元线性回归，以确定维生素D水平的显著预测因素。
该队列的平均年龄为67.70±8.95岁，平均BMI为31.00±5.71 kg/m²。总体而言，33.9%的患者维生素D缺乏，另有32.9%不足，只有33.2%充足。维生素D水平随季节有显著变化，并与肥胖和吸烟有关。具体而言，BMI与维生素D水平之间存在微弱的显著负相关（r = -0.17，P < 0.01）。此外，经常吸烟与较低的维生素D水平有关（r = 0.14，P < 0.01）。多元线性回归分析显示，年龄、BMI、吸烟和季节是术前维生素D水平的微弱显著预测因素（R = 0.15，调整后R = 0.12）。共有121例（17.61%）患者报告在手术前常规摄入维生素D。补充维生素D的患者平均血清维生素D水平显著更高，住院平均时间显著缩短（P < 0.01）。
择期初次TKA患者维生素D不足和缺乏的患病率高得惊人。在持续努力优化TKA手术的疗效和结果时，应建议骨科医生在其常规实践中大力重视围手术期维生素D水平的作用。
