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Lack of supplementation yielded low vitamin D levels in patients undergoing shoulder arthroplasty
Researcher noted patients need to be equipped with preoperative counseling.
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Lower serum 25-hydroxyvitamin D levels were predicted by the absence of supplementation with vitamin D or calcium prior to serum testing in patients undergoing shoulder arthroplasty, according to a study.
“Most orthopedic surgeons, and rightfully so, focus on the technical steps required for a successful operation. However, as more and more data eludes to its importance, metabolic and nutritional factors may be of equal magnitude,” Bradley P. Inkrott, MD, chief orthopedic surgery resident at Summa Health System, told Orthopedics Today. “Most believe good technique leads to good outcomes, but it may not be that simple. I think certainly the evidence is growing that the patients need to be equipped with preoperative counseling and that involves laboratory workup, smoking, counseling, BMI, etc.”
Vitamin D insufficiency
Inkrott and his colleagues screened 218 patients undergoing total shoulder arthroplasty (TSA), reverse TSA or hemiarthroplasty between September 2013 and December 2014 for hypovitaminosis D.
Results showed 43% of patients were vitamin D insufficient and 11% were vitamin D deficient. Compared with patients with a BMI of less than 30 kg/m2, there were decreased mean vitamin D levels among patients with a BMI of 30 kg/m2 or greater. Risk factors for hypovitaminosis D included lack of vitamin D or calcium supplementation prior to serum testing and a BMI of 30 kg/m2 or greater, while gender, race, smoking status, American Society of Anesthesiologists score, procedure type and surgical indication were not statistically significant. Univariate analysis showed vitamin D insufficiency and deficiency in 18 and in four of 101 patients who received supplementation of vitamin D of calcium prior to serum testing, respectively.
“The reason why we did the study was because we had a few [acromial] stress fractures, which have several risk factors; one of which being poor bone quality in the setting of a shoulder arthroplasty. We postulated that if people had normal vitamin D, then we could potentially mitigate this complication,” Inkrott said. “But in the literature review, we discovered that vitamin D is involved in a host of other things, including infection, bone healing and potential stress fracture risk.”
Awareness in bone health
Inkrott noted he hopes this research will raise awareness about bone healing and bone quality in patients undergoing shoulder arthroplasty, as well as help direct future studies on discovering what may occur if deficient vitamin D levels are replaced clinically. Although Inkrott and his colleagues have yet to connect the outcomes, he hopes to do so through the collection of ongoing data.
“We are a high-volume center, so the goal is eventually assess outcomes prospectively from an infection and shoulder function standpoint,” Inkrott said. “The stress fracture complication rate is low, and I do not think we will ever achieve that significance, but that is more of a theoretical question.” – by Casey Tingle
- Reference:
- Inkrott BP, et al. Orthopedics. 2016;doi:10.3928/01477447-20160606-04.
- For more information:
- Bradley P. Inkrott, MD, can be reached at the department of orthopedic surgery at Summa Health System, 444 North Main St., Akron, OH 44310; email: binkrott@gmail.com.
Disclosure: Inkrott reports no relevant financial disclosures.