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Vitamin D deficiency in patients with osteoarthritis undergoing total hip replacement: A CAUSE FOR CONCERN?
J Bone Joint Surg Br. 2010 Apr;92(4):496-9.
Nawabi DH, Chin KF, Keen RW, Haddad FS.
Department of Trauma and Orthopaedics University College Hospital, 235 Euston Road, London NW1 2BU, UK.
We measured the plasma 25-hydroxyvitamin D(3) OH)D(3? levels in 62 consecutive Caucasian patients undergoing total hip replacement for osteoarthritis. The patients were divided into two groups based on whether they were vitamin D sufficient or deficient. The groups were matched for age, gender and the American Society of Anaesthesiologists (ASA) grade. The prevalence of vitamin D deficiency in our patients was comparable with recent population-based studies performed in the United Kingdom. Patients with vitamin D deficiency had lower pre-operative Harris hip scores (Mann-Whitney test, p = 0.018) and were significantly less likely to attain an excellent outcome from total hip replacement (chi-squared test, p = 0.038).
Vitamin D levels were found to positively correlate with both pre- and post-operative Harris hip scores. These results warrant further study of vitamin D deficiency in patients undergoing joint replacement as it is a risk factor for a suboptimal outcome which is relatively simple and cheap to correct. PMID: 20357324
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Resurfacing total hip replacement--a therapeutical approach in postmenopausal women with osteoporosis and hip arthrosis.
J Med Life. 2011 May 15;4(2):178-81. Epub 2011 May 25.
Popescu D, Ene R, Cirstoiu C.
Orthopedics-Traumatology Clinic, University Hospital, Bucharest, Romania.
AIM: Patients with incipient hip arthrosis may benefit from a relatively new therapeutical approach using resurfacing total hip replacement, but in those with associated osteoporosis, this type of surgical intervention is contraindicated, given the poor quality of osteoporotic bones. We assessed the efficacy of the antiosteoporotic pharmacological therapy to improve bone quality and bone strength in postmenopausal women diagnosed with hip arthrosis and osteoporosis thus facilitating the hip surgical intervention.
METHODS: We evaluated 20 postmenopausal women aged between 53-60 years diagnosed with osteoporosis according to the WHO criteria, by using dual-energy X-ray absorptiometry (DXA) for bone mineral density measurements. All these patients had low hip T score (osteopenia/ osteoporosis) and also incipient hip arthrosis. The surgical approach was delayed for 12 months and all the patients received bisphosphonate therapy with calcium and vitamin D supplements. DXA scans were performed after 12 months of therapy in all the patients.
RESULTS: A surgical intervention with resurfacing total hip replacement was performed in 12 of the 16 patients presenting with increasing BMD, 4 of them showing elements of rapidly advancing hip arthrosis to a stage that made this type of intervention impossible. We chose not to use this technique in the group with stable BMD (4 patients). All 12 women surgically treated had a favorable post-operative outcome without experiencing a femoral neck fracture during the surgical intervention or during the twelve-month follow-up. All 20 patients continued to receive bisphosphonate therapy.
CONCLUSION: In postmenopausal women with osteoporosis and associated hip arthrosis, improving bone mass and bone quality with bisphosphonate therapy is necessary and important in order to allow hip arthroplasty, by using the technique of resurfacing, avoiding the risk of intra-operative fractures and with a favorable post-operative long-term outcome.
PDF is attached at bottom of this page
Strangely Vitamin D is not in the PDF except for the abstract
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A study which found no association after 6 weeks - July 2012
Low Vitamin D Status Does Not Adversely Affect Short-Term Functional Outcome After Total Hip Arthroplasty.
J Arthroplasty. 2012 Jul 12.
Unnanuntana A, Saleh A, Nguyen JT, Sculco TP, Cornell CN, Mancuso CA, Lane JM.
Department of Orthopaedic Surgery, Siriraj Hospital, Mahidol University, Bangkok, Thailand; Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York.
We prospectively measured functional performances (Western Ontario and McMaster Universities Osteoarthritis Index, Short Form-36, 2-minute walk test, and timed get-up-and-go test) of patients who underwent total hip arthroplasty (THA) and had serum vitamin D levels tested during the preoperative evaluation. Of 219 patients, 102 (46.6%) had low vitamin D levels (25-hydroxyvitamin D<30 ng/mL). Low vitamin D status did not adversely affect short-term function at 6 weeks after THA. In addition, there was no association between serum vitamin D levels and the within-patient changes of scores of each outcome measurement. Because this 6-week period is generally adequate to correct vitamin D deficiency, orthopedic surgeons can safely perform THA without delay. Nevertheless, because vitamin D deficiency impairs bone quality, patients with low vitamin D levels should be treated once identified.
Copyright © 2012 Elsevier Inc. All rights reserved.
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