Trends in vitamin D and its influence on outcomes following total hip and knee arthroplasty

Abstract

There is increasing interest in the extra-skeletal effects of vitamin D. In patients undergoing total hip (THR) or knee (TKR) replacement surgery, insufficiency has been linked to adverse outcomes including longer length of stay, lower patient reported outcome measure scores (PROMs), and increased complication rates. This work aims to explore this further. Using vitamin D data from an NHS hospital trust, the temporal trends in the local population were explored. Vitamin D levels in patients undergoing THR and TKR were measured and linked to Oxford and EQ-5D-3L scores to determine if baseline vitamin D status is associated with post-operative outcome. The current evidence base for optimising vitamin D levels with supplementation prior to arthroplasty surgery was sought through a systematic review. Finally, a randomised trial to establish the feasibility of supplementing patients with insufficiency prior to surgery to improve outcomes was completed. The influence of this feasibility study in the design of future interventional trials is discussed. This work has shown increasing trends in vitamin D testing in the local population. Preoperative deficiency is associated with lower PROM scores following THR/TKR. There is a paucity of evidence for supplementation prior to arthroplasty surgery, but a randomised trial investigating the role of optimising vitamin D levels with supplementation is feasible. Suggestions for how this could be done in the NHS setting are discussed, and future studies should develop this work through adequately powered multicentre trials.