Vitamin D deficiency and risk of postoperative complications in joint arthroplasty: a meta-analysis

Vitamin D deficiency is prevalent among patients undergoing joint arthroplasty and may influence surgical outcomes. This meta-analysis aimed to evaluate the association between preoperative vitamin D deficiency and postoperative complications following joint arthroplasty. A systematic search was conducted in PubMed/MEDLINE, Embase, Cochrane Library, Web of Science and Scopus from inception to January 2025. Random-effects models were used to calculate pooled odds ratios (ORs) and standardized mean differences (SMDs). Subgroup analyses were performed based on study design, joint type, vitamin D threshold and follow-up duration. Twenty-three studies (8,762 patients) were included. Vitamin D deficiency was significantly associated with increased risk of overall postoperative complications (OR 2.18, 95% CI 1.76-2.69), periprosthetic joint infection (OR 2.83, 95% CI 2.05-3.91), superficial surgical site infection (OR 1.89, 95% CI 1.45-2.47), aseptic loosening (OR 1.76, 95% CI 1.38-2.25), prosthetic dislocation (OR 1.82, 95% CI 1.31-2.53) and revision surgery (OR 2.25, 95% CI 1.72-2.94). Functional outcomes were significantly worse in vitamin D-deficient patients at 6 months and 12 months postoperatively. The association between vitamin D deficiency and complications was strongest with the <10 ng/mL threshold. Preoperative vitamin D deficiency is significantly associated with increased risk of multiple complications and poorer functional outcomes following joint arthroplasty. The risk appears to increase with the severity of deficiency suggesting that vitamin D status represent a modifiable risk factor. Future research should investigate whether preoperative vitamin D supplementation can reduce complication risk and improve outcomes.