Total Hip or Knee Arthroplasty: 4 more days in hospital if low Vitamin D
Impact of Preoperative Nutritional Status on Postoperative Outcomes of Total Hip and Knee Arthroplasty: A Scoping Review
Medicina Volume 62 Issue 5 May 2026 10.3390/medicina62050958 by Mariana Garay-Álvarez 1ORCID,Juanita Fetecua-Chaparro 1ORCID,Paula A. Rodríguez-Molina 1ORCID,Giovanni Rodríguez-Rojas 1ORCID,Isabela Álvarez-Rivas 1,Eduardo Tuta-Quintero 2ORCID,Fernando Ríos-Barbosa 3,* and Juan G. Ortiz-Martínez 4
Background and Objectives: Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are widely performed procedures with high success rates but relevant postoperative complications. Preoperative nutritional status is a key modifiable risk factor influencing surgical outcomes. This study aimed to map and synthesize the available evidence on the association between preoperative nutritional status and postoperative complications in patients undergoing primary THA or TKA. Materials and
Methods: A scoping review was conducted following PRISMA-ScR guidelines. A comprehensive search was performed in PubMed, ScienceDirect, and Scopus, with the last update conducted in April 2026. Studies published between 2015 and 2026 in English and Spanish were included. Eligibility criteria followed the PCC framework. Randomized controlled trials and observational studies were included. Risk of bias was assessed using the Newcastle–Ottawa Scale for observational studies and the Cochrane Risk of Bias tool for randomized trials.
Results: A total of 1126 records were identified, and 23 studies were included, comprising 447,852 patients. Nutritional status was mainly assessed using serum biomarkers, particularly albumin, followed by anthropometric measures, combined indices, and micronutrients. Poor nutritional status, especially hypoalbuminemia, vitamin D deficiency, and low BMI, was associated with higher rates of infectious complications, prolonged hospital stay, increased readmissions and mortality, and worse functional recovery.
Conclusions: Preoperative nutritional assessment is essential for perioperative risk stratification in THA and TKA. Integrating biomarkers, indices, and targeted interventions may improve outcomes and reduce postoperative complications.
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- "Additionally, observational analyses associate vitamin D deficiency with a 4.3-day longer hospital stay compared with patients with sufficient levels [5,23]. All reported effect measures are detailed in Table 1."
- "Regarding pharmacological intervention, preoperative administration of a single 300,000 IU dose of vitamin D3 in deficient patients reduced the overall complication rate from 8.6% to 4.3% (p = 0.005), indicating a protective effect, with an adjusted OR of 15.01 for reducing the risk of superficial wound complications compared with the non-supplemented group [18]."