Vitamin D deficiency is associated with worse implant-related complications following total knee arthroplasty

Vitamin D deficiency (VDD) can lead to several health risks such as bone disorders and increase susceptibility to infections and muscle weakness. Studies have shown patients with VDD is associated with worse surgical outcomes. The aim of this study is to investigate whether patients with vitamin D deficiency are associated with increased likelihood of (1) 90-day medical complications, and (2) 2-year implant-related complications. In addition, we explore a sub analysis of patients who received cemented fixation only, evaluating the same outcomes. A retrospective analysis was conducted using the PearlDiver database to identify patients with and without vitamin D deficiency within three months prior to a primary total knee arthroplasty (TKA). Patients with a preexisting diagnosis of osteoporosis were excluded. A 1:5 propensity score matching was performed using variables such as tobacco use, obesity, coronary artery disease, chronic kidney disease, and ECI scores. The query identified a total of 218,277 patients (vitamin D deficiency = 36,452; non-deficient = 181,825). Medical complications within 90 days and implant-related complications over a two-year period were analyzed. A P-value less than 0.001 was considered statistically significant. Vitamin D deficiency was associated with increased odds of medical complications within 90 days post-TKA, including malnutrition (Odds Ratio [OR], 2.44; P < 0.001), deep vein thrombosis (OR, 2.07; P < 0.001), venous thromboembolism (OR, 1.33; P < 0.001), myocardial infarction (OR, 1.30; P = 0.01), pneumonia (OR, 1.27; P < 0.001), acute kidney injury (OR, 2.03; P < 0.001) and hypoglycemia (OR, 2.39; P < 0.001). VDD was associated with lower risk of pulmonary embolism (OR, 0.38; P < 0.001) and surgical site infection (OR, 0.52; P < 0.001). There was no significant difference between the VDD and the control cohorts in the rate of cerebrovascular accident (OR, 0.99; P = 0.92) and sepsis ( P = 0.48). VDD was associated with increased risk of implant-related complications within two years, including revisions (OR, 1.75; P < 0.001), instability (OR, 2.28; P < 0.001), aseptic loosening (OR, 3.46; P < 0.001) and periprosthetic fracture (OR, 1.80; P < 0.001). The only exception was periprosthetic joint infection (OR, 0.82; P < 0.001). The VDD cohort receiving cement only demonstrated nonsignificant differences compared to controls in rates of periprosthetic fractures (OR 1.07; P = 0.70), aseptic loosening (OR 1.28; P = 0.035) and instability (OR 1.31; P = 0.015). 001) compared to controls. This study demonstrated patients with vitamin D deficiency are associated with higher risks of medical complications within 90 days and implant-related complications within two years following TKA compared to the matched cohort. Vitamin D deficiency patients receiving cement only demonstrated no significant differences in periprosthetic fractures, aseptic loosening or instability when compared to the control group.