Influence of hypovitaminosis D on the condition of patients before and after joint replacement (literature review)

Vladyslav Povoroznyuk, Ninel Dedukh


The joint replacement is one of the most common orthopedic procedures and is an effective method to restore joint function, patient's activity, to correct limb discrepancy and to eliminate pain syndrome. Over the past few decades, the success of joint replacement has led to a sharp increase in the number of surgeries performed annually all over the world, including Ukraine. However, despite of a significant number of long-term positive outcomes of this surgical intervention, minimization of postoperative complications remains a topical issue for surgeons. The unmodifiable and modifiable risk factors are distinguished, among them a special attention is paid to the vitamin D, which has a pleiotropic effect on the organs and tissues. A literature review highlights the prevalence of vitamin D deficiency and its insufficiency in patients before and after the hip or knee arthroplasties. Some negative effects of this surgical treatment were detected at hypovitaminosis, and being proven by clinical studies: increased rates of periprosthetic joint infection and revision surgeries, length of patients’ hospitalization. The reference data on the normal vitamin D concentration in blood serum reveal its antibacterial effect, which helps to reduce the risk of periprosthetic infection; to increase muscle strength and to reduce the tendency of falls. Further research is needed to determine the relationship between the vitamin D levels and state of patients after joint arthroplasty. The study of the vitamin D therapy and its effect on the condition of patients before and after arthroplasty would be especially promising.


deficiency and insufficiency of vitamin D; arthroplasty of large joints


Korzh, N. A., Filippenko, V. A., & Tankut, V. A. (2016). State of the problem of joint replacement in Ukraine. Trauma, 17 (3), 25–26. (in Russian)

Loskutov, A. E., & Vasilchenko, A. E. (2014). Errors and complications in hip joint replacement using cement technology. Medical Prospects, 19 (1), 50–56. (in Russian)

Filippenko, V. A., Dedukh, N. V., & Pidgaiska, O. A. (2012). Experience in the use of the drug alpha D3-Teva in patients after hip replacement. Ukrainian Rheumatology Journal, 3(49), 48–51. (in Russian)

Pivec, R., Johnson, A. J., Mears, S. C., & Mont, M. A. (2012). Hip arthroplasty. The Lancet, 380 (9855), 1768–1777. doi:10.1016/s0140-6736(12)60607-2

Karachalios, T., Komnos, G., & Koutalos, A. (2018). Total hip arthroplasty. EFORT Open Reviews, 3 (5), 232–239. doi:10.1302/2058-5241.3.170068

Prikhod'ko, V. S., Tarbushkin, A. A., Prokhorova, M. Y., Shilin, A. P., Usmanov, D. N., & Morozov, D. S. (2015). Risks of endoprosthetic replacement of large joints in patients with obesity. Obesity and metabolism, 12 (4), 2–56. doi: 10.14341/OMET2015452-56. (in Russian)

Ali, A., Lindstrand, A., Sundberg, M., & Flivik, G. (2017). Preoperative anxiety and depression correlate with dissatisfaction after total knee arthroplasty: a prospective longitudinal cohort study of 186 patients, with 4-year follow-up. The Journal of Arthroplasty, 32 (3), 767–770. doi:10.1016/j.arth.2016.08.033

Bohl, D. D., Shen, M. R., Kayupov, E., Cvetanovich, G. L., & Della Valle, C. J. (2016). Is hypoalbuminemia associated with septic failure and acute infection after revision total joint arthroplasty? A study of 4517 patients from the National Surgical Quality Improvement Program. The Journal of Arthroplasty, 31 (5), 963–967. doi:10.1016/j.arth.2015.11.025

George, J., Newman, J. M., Ramanathan, D., Klika, A. K., Higuera, C. A., & Barsoum, W. K. (2017). Administrative databases can yield false conclusions — an example of obesity in total joint arthroplasty. The Journal of Arthroplasty, 32 (9), S86–S90. doi:10.1016/j.arth.2017.01.052

Issa, K., Boylan, M. R., Naziri, Q., Perfetti, D. C., Maheshwari, A. V., & Mont, M. A. (2015). The impact of hepatitis c on short-term outcomes of total joint arthroplasty. The Journal of Bone and Joint Surgery. American Volume, 97 (23), 1952–1957. doi:10.2106/jbjs.o.00183

Maier, G. S., Maus, U., Lazovic, D., Horas, K., Roth, K. E., & Kurth, A. A. (2016). Is there an association between low serum 25-OH-D levels and the length of hospital stay in orthopaedic patients after arthroplasty? Journal of Orthopaedics and Traumatology, 17 (4), 297–302. doi:10.1007/s10195-016-0414-y

Maier, G. S., Jakob, P., Horas, K., Roth, K. E., Kurth, A. A., & Maus, U. (2013). Vitamin D deficiency in orthopaedic patients: a single center analysis. Acta Orthopaedica Belgica, 79 (5), 587–591.

Schwartz, F. H., & Lange, J. (2017). Factors that affect outcome following total joint arthroplasty: a review of the recent literature. Current Reviews in Musculoskeletal Medicine, 10 (3), 346–355. doi:10.1007/s12178-017-9421-8

Duchman, K. R., Gao, Y., Pugely, A. J., Martin, C. T., Noiseux, N. O., & Callaghan, J. J. (2015). The effect of smoking on short-term complications following total hip and knee arthroplasty. The Journal of Bone and Joint Surgery, 97 (13), 1049–1058. doi:10.2106/jbjs.n.01016

Singh, J. A., Houston, T. K., Ponce, B. A., Maddox, G., Bishop, M. J., Richman, J., & Hawn, M. T. (2011). Smoking as a risk factor for short-term outcomes following primary total hip and total knee replacement in veterans. Arthritis Care & Research, 63 (10), 1365–1374. doi:10.1002/acr.20555

Tischler, E. H., Matsen Ko, L., Chen, A. F., Maltenfort, M. G., Schroeder, J., & Austin, M. S. (2017). Smoking increases the rate of reoperation for infection within 90 days after primary total joint arthroplasty. The Journal of Bone and Joint Surgery, 99 (4), 295–304. doi:10.2106/jbjs.16.00311

Povorozniuk, V. V., & Plodowski, P. (Ed.) (2014). Vitamin D Deficiency and Deficiency: Epidemiology, Diagnosis, Prevention and Treatment. Donetsk: Publisher Zaslavskiy O. Yu. (in Ukrainian)

Kulie, T., Groff, A., Redmer, J., Hounshell, J., & Schrager, S. (2009).Vitamin D: an evidence-based review. Journal of the American Board of Family Medicine, 22 (6), 698–706. doi: 10.3122/jabfm.2009.06.090037.

Heath, A., Kim, I., Hodge, A., English, D., & Muller, D. (2019). Vitamin D status and mortality: a systematic review of observational studies. International Journal of Environmental Research and Public Health, 16 (3), 383. doi:10.3390/ijerph16030383

Płudowski, P., Karczmarewicz, E., Bayer, M. & [et al.] (2013). Methodological guidelines for the treatment and prevention of vitamin D deficiency in the population of Central Europe: recommended doses of vitamin D for healthy populations and at-risk populations. Pain. Joints. Spine, 11, 7–12. (in Ukrainian)

Hossein-nezhad, A., & Holick, M. F. (2013). Vitamin D for Health: A Global Perspective. Mayo Clinic Proceedings, 88 (7), 720–755. doi:10.1016/j.mayocp.2013.05.011

Povoroznyuk, V. V., Dedukh, N. V., & Yakovenchuk, N. M. (2018). Vitamin D and osteoarthritis, 8 (1), 14–23. doi: 10.22141/2224-1507.8.1.2018.130693. (in Ukrainian)

Povoroznyuk, V., Dedukh, N., & Shinkarenko, T. (2018). Deficiency and lack of vitamin d, polimorphism of the gene receptor of vitamin d and their influence on the intervertebral disc and back pain (literature review). Orthopedics, traumatology and prosthetics, 3, 107–116. doi: 10.15674/0030-598720183107-116. (in Ukrainian)

Bogunovic, L., Kim, A. D., Beamer, B. S., Nguyen, J., & Lane, J. M. (2010). Hypovitaminosis D in patients scheduled to undergo orthopaedic surgery. The Journal of Bone and Joint Surgery-American Volume, 92 (13), 2300–2304. doi:10.2106/jbjs.i.01231

Fu, M. C., McLawhorn, A. S., Padgett, D. E., & Cross, M. B. (2016). Hypoalbuminemia is a better predictor than obesity of complications after total knee arthroplasty: a propensity score-adjusted observational analysis. HSS Journal, 13 (1), 66–74. doi:10.1007/s11420-016-9518-4

Inkrott, B. P., Koberling, J. L., & Noel, C. R. (2016). Hypovitaminosis D in patients undergoing shoulder arthroplasty: a single-center analysis. Orthopedics, 39 (4), e651–e656. doi:10.3928/01477447-20160606-04

Michelson, J. D., & Charlson, M. D. (2015). Vitamin D status in an elective orthopedic surgical population. Foot & Ankle International, 37 (2), 186–191. doi:10.1177/1071100715609054

Felson, D. T., Niu, J., Clancy, M., Aliabadi, P., Sack, B., Guermazi, A., & Booth, S. L. (2007). Low levels of vitamin D and worsening of knee osteoarthritis: Results of two longitudinal studies. Arthritis & Rheumatism, 56 (1), 129-136. doi:10.1002/art.22292

Glowacki, J., Hurwitz, S., Thornhill, T. S., Kelly, M., & Leboff, M. S. (2003). Osteoporosis and vitamin-D deficiency among postmenopausal women with osteoarthritis undergoing total hip arthroplasty. The Journal of Bone and Joint Surgery. American Volume, 85 (12), 2371–2377. doi:10.2106/00004623-200312000-00015

Bischoff, H. A., Stähelin, H. B., Dick, W., Akos, R., Knecht, M., Salis, C., & Conzelmann, M. (2003). Effects of Vitamin D and calcium supplementation on falls: a randomized controlled trial. Journal of Bone and Mineral Research, 18 (2), 343–351. doi:10.1359/jbmr.2003.18.2.343

Stockton, K. A., Mengersen, K., Paratz, J. D., Kandiah, D., & Bennell, K. L. (2011). Effect of vitamin D supplementation on muscle strength: a systematic review and meta-analysis. Osteoporosis International, 22 (3), 859–871. doi:10.1007/s00198-010-1407-y

Breijawi, N., Eckardt, A., Pitton, M., Hoelzl, A., Giesa, M., Von Stechow, D., & Drees, P. (2009). Bone mineral density and vitamin D status in female and male patients with osteoarthritis of the knee or hip. European Surgical Research, 42 (1), 1–10. doi:10.1159/000166164

Nawabi, D. H., Chin, K. F., Keen, R. W., & Haddad, F. S. (2010). Vitamin D deficiency in patients with osteoarthritis undergoing total hip replacement. The Journal of Bone and Joint Surgery. British volume, 92-B (4), 496–499. doi:10.1302/0301-620x.92b3.23535

Mäkinen, T. J., Alm, J. J., Laine, H., Svedström, E., & Aro, H. T. (2007). The incidence of osteopenia and osteoporosis in women with hip osteoarthritis scheduled for cementless total joint replacement. Bone, 40 (4), 1041–1047. doi:10.1016/j.bone.2006.11.013

Allain, T. J., Beresford, P. A., Newman, J. H., & Swinkels, A. (2008). Vitamin D levels in patients undergoing knee arthroplasty: Does vitamin D status effect postoperative outcomes? e-SPEN, the European e-Journal of Clinical Nutrition and Metabolism, 3 (1), e17–e21. doi:10.1016/j.eclnm.2007.10.002

Jansen, J., & Haddad, F. (2013). High prevalence of vitamin D deficiency in elderly patients with advanced osteoarthritis scheduled for total knee replacement associated with poorer preoperative functional state. Annals of The Royal College of Surgeons of England, 95 (8), 569–572. doi:10.1308/003588413x13781990150374

Goula, T., Kouskoukis, A., Drosos, G., Tselepis, A., Ververidis, A., Valkanis, C., & Kazakos, K. (2015). Vitamin D status in patients with knee or hip osteoarthritis in a Mediterranean country. Journal of Orthopaedics and Traumatology, 16 (1), 35–39. doi:10.1007/s10195-014-0322-y

Lavernia, C. J., Villa, J. M., Iacobelli, D. A., & Rossi, M. D. (2013). Vitamin D insufficiency in patients with THA: prevalence and effects on outcome. Clinical Orthopaedics and Related Research, 472 (2), 681–686. doi:10.1007/s11999-013-3172-7

Lee, A., Chan, S. K., Samy, W., Chiu, C. H., & Gin, T. (2015). Effect of hypovitaminosis D on postoperative pain outcomes and short-term health-related quality of life after knee arthroplasty. Medicine, 94 (42), e1812. doi:10.1097/md.0000000000001812

Maier, G. S., Horas, K., Seeger, J. B., Roth, K. E., Kurth, A. A., & Maus, U. (2014). Is there an association between periprosthetic joint infection and low vitamin D levels? International Orthopaedics, 38 (7), 1499–1504. doi:10.1007/s00264-014-2338-6

Shin, K., Park, K. K., Moon, S., Yang, I. H., Choi, H., & Lee, W. (2016). Vitamin D deficiency adversely affects early post-operative functional outcomes after total knee arthroplasty. Knee Surgery, Sports Traumatology, Arthroscopy, 25 (11), 3424–3430. doi:10.1007/s00167-016-4209-8

Traven, S. A., Chiaramonti, A. M., Barfield, W. R., Kirkland, P. A., Demos, H. A., Schutte, H. D., & Drew, J. M. (2017). Fewer complications following revision hip and knee arthroplasty in patients with normal vitamin D levels. The Journal of Arthroplasty, 32 (9), S193–S196. doi:10.1016/j.arth.2017.02.038

Zajonz, D., Prager, F. L., Edel, M., Möbius, R., Daikos, A., Fakler, J., & Roth, A. (2018). The significance of the vitamin D metabolism in the development of periprosthetic infections after THA and TKA: a prospective matched-pair analysis of 240 patients. Clinical Interventions in Aging, Volume 13, 1429–1435. doi:10.2147/cia.s171307

Reid, D., Toole, B. J., Knox, S., Talwar, D., Harten, J., O’Reilly, D. S., & Wallace, A. M. (2011). The relation between acute changes in the systemic inflammatory response and plasma 25-hydroxyvitamin D concentrations after elective knee arthroplasty. The American Journal of Clinical Nutrition, 93 (5), 1006–1011. doi:10.3945/ajcn.110.008490

Baker, P. N., Van der Meulen, J. H., Lewsey, J., & Gregg, P. J. (2007). The role of pain and function in determining patient satisfaction after total knee replacement. The Journal of Bone and Joint Surgery. British volume, 89-B (7), 893–900. doi:10.1302/0301-620x.89b7.19091

Khan, J., Ahmed, R., & Akhtar, R. R. (2019). Effect of pre-operative serum vitamin-D levels on post-operative outcome in total knee arthroplasty. Journal of Postgraduate Medical Institute, 33 (1), 78–82.

Hegde, V., Arshi, A., Wang, C., Buser, Z., Wang, J. C., Jensen, A. R., & Bernthal, N. M. (2018). Preoperative vitamin D deficiency is associated with higher postoperative complication rates in total knee arthroplasty. Orthopedics, 41 (4), e489–e495. doi:10.3928/01477447-20180424-04

Iglar, P. J., & Hogan, K. J. (2015). Vitamin D status and surgical outcomes: a systematic review. Patient Safety in Surgery, 9 (1). doi:10.1186/s13037-015-0060-y

Unnanuntana, A., Saleh, A., Nguyen, J. T., Sculco, T. P., Cornell, C. N., Mancuso, C. A., & Lane, J. M. (2013). Low vitamin D status does not adversely affect short-term functional outcome after total hip arthroplasty. The Journal of Arthroplasty, 28 (2), 315–322.e2. doi:10.1016/j.arth.2012.04.027

Visser, E., De Roos, N., Oosting, E., Endenburg, S., & Dronkers, J. (2018). Association between preoperative vitamin D status and short-term physical performance after total hip arthroplasty: a prospective study. Annals of Nutrition and Metabolism, 73 (3), 252–260. doi:10.1159/000492938

Morrison, R. J., Bunn, D., Gray, W. K., Baker, P. N., White, C., Rangan, A., & Reed, M. R. (2017). VASO (Vitamin D and Arthroplasty Surgery Outcomes) study - supplementation of vitamin D deficiency to improve outcomes after total hip or knee replacement: study protocol for a randomised controlled feasibility trial. Trials, 18 (1). doi:10.1186/s13063-017-2255-2

Dhesi, J. K., Jackson, S. H., Bearne, L. M., Moniz, C., Hurley, M. V., Swift, C. G., & Allain, T. J. (2004). Vitamin D supplementation improves neuromuscular function in older people who fall. Age and Ageing, 33 (6), 589–595. doi:10.1093/ageing/afh209

Maniar, R. N., Patil, A. M., Maniar, A. R., Gangaraju, B., & Singh, J. (2016). Effect of preoperative vitamin D levels on functional performance after total knee arthroplasty. Clinics in Orthopedic Surgery, 8 (2), 153. doi:10.4055/cios.2016.8.2.153

Tran, E. Y., Uhl, R. L., & Rosenbaum, A. J. (2017). Vitamin D in Orthopaedics. JBJS Reviews, 5(8), e1. doi:10.2106/jbjs.rvw.16.00084

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