Preoperative Vitamin D Deficiency Is Associated With Higher Postoperative Complications in Arthroscopic Rotator Cuff Repair

Garrett K Harada, Armin Arshi, Nickolas Fretes, Blake Formanek, Seth Gamradt, David R McAllister, Frank A Petrigliano, Garrett K Harada, Armin Arshi, Nickolas Fretes, Blake Formanek, Seth Gamradt, David R McAllister, Frank A Petrigliano

Abstract

Introduction: Rotator cuff tears are one of the most common injuries worldwide, yet it is difficult to predict which patients will have poor outcomes after arthroscopic rotator cuff repair (RCR). The purpose of this study was to identify an association between preoperative vitamin D (25D) levels and postoperative complications in arthroscopic RCR.

Methods: From a national claims database, patients undergoing arthroscopic RCR with preoperative 25D levels were reviewed. Patients were stratified into 25D-sufficient (≥20 ng/dL) or 25D-deficient (<20 ng/dL) categories and examined for development of postoperative complications. Multivariate logistic regression was performed using age, sex, and Charlson Comorbidity Index (CCI) as covariates. From this, risk-adjusted odds ratios (ORs) were calculated comparing complications between the two groups.

Results: One thousand eight hundred eighty-one patients with measured preoperative 25D levels were identified; 229 patients were 25D deficient (12.2%). After adjusting for age, sex, and Charlson Comorbidity Index, 25D-deficient patients had increased odds of revision RCR (OR 1.54, 95% confidence interval 1.21 to 1.97, P < 0.001) and stiffness requiring manipulation under anesthesia (OR 1.16, 95% confidence interval 1.03 to 2.03, P = 0.035).

Conclusions: Vitamin D deficiency is associated with a greater risk of postoperative surgical complications after arthroscopic RCR and may be a modifiable risk factor. Further investigation on preoperative vitamin D repletion is warranted.

Copyright © 2019 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Orthopaedic Surgeons.

References

    1. Levels of evidence are described in the table of contents. In this article, references 3, 7, 12, 13, 14, and 27 are level II studies. References 1, 6, 10, 22, 23, and 29 are level III studies. References 4, 5, 11, 15, 17, 18, 20, 24, 25, 26, 28, 30, and 33 are level IV studies. References 2, 8, 9, 16, 19, 21, 31, 32, and 34 are level V studies.

    1. Yamamoto A, Takagishi K, Osawa T: Prevalence and risk factors of a rotator cuff tear in the general population. J Shoulder Elb Surg 2010;19:116-120.
    1. Sambandam SN, Khanna V, Gul A, Mounasamy V: Rotator cuff tears: An evidence based approach. World J Orthop 2015;6:902-918.
    1. Milgrom C, Schaffler M, Gilbert S, Holsbeeck M: Rotator-cuff changes in asymptomatic adults. J Bone Joint Surg 1995;77:296-298.
    1. Oh LS, Wolf BR, Hall MP, Levy BA, Marx RG: Indications for rotator cuff repair: A systematic review. Clin Orthop Relat Res 2007;455:52-63.
    1. Sher J, Uribe J, Posada A, Murphy B, Zlatkin M: Abnormal findings on magnetic resonance images of asymptomatic shoulders. J Bone Joint Surg 1995;77:10-15.
    1. Chung SW, Oh JH, Gong HS: Factors affecting rotator cuff healing after arthroscopic repair osteoporosis as one of the independent risk factors. Am J Sports Med 2008;39:2099-2107.
    1. Sprague S, Petrisor B, Scott T, et al. : What is the role of vitamin D supplementation in acute fracture patients? A systematic review and meta-analysis of the prevalence of hypovitaminosis D and supplementation efficacy. J Orthop Trauma 2015;30:1.
    1. Watkins RR, Lemonovich TL, Salata RA: An update on the association of vitamin D deficiency with common infectious diseases. Can J Physiol Pharmacol 2015;93:363-368.
    1. Oda Y, Tu C, Menendez A, Nguyen T, Bikle DD: Vitamin D and calcium regulation of epidermal wound healing. J Steroid Biochem Mol Biol 2017;1:379-385.
    1. Hegde V, Arshi A, Wang C, et al. : Associated with higher postoperative complication rates in total knee arthroplasty. Orthopedics 2018;201:1-7.
    1. Hatfield DP, Sweeney KP, Lau J, Lichtenstein AH: Critical assessment of high-circulation print newspaper coverage of the Institute of Medicine report dietary reference intakes for calcium and vitamin D. Public Health Nutr 2014;17:1868-1876.
    1. Charlson ME, Pompei P, Ales KL, Mackenzie CR: A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987;40:373-383.
    1. Nurmi-Luthje I, Luthje P, Kataja M: Positive effects of a sufficient pre-fracture serum vitamin D level on the long-term survival of hip fracture patients in Finland: A minimum 11-year follow-up. Drugs Aging 2015;32:477-486.
    1. Maier GS, Horas K, Seeger JB, Roth KE: Is there an association between periprosthetic joint infection and low vitamin D levels? Int Orthop 2014;38:1499-504.
    1. Rebolledo B, Bernard J, Rodeo S: Extremity muscle strains and core muscle injuries at the national football league combine. J Arthrosc Relat Surg 2018;34:1280-1285.
    1. Pascual-garrido C, Angeline ME, Ma R, et al. : Low levels of vitamin D have a deleterious effect on the articular cartilage in a rat model. HSS J 2016;12:150-157.
    1. Diebold G, Lam P, Walton J, Murrell GAC: Relationship between age and rotator cuff retear. J Bone Joint Surg 2017;99-A:1198-1205.
    1. Galatz LM, Ball CM, Yamaguchi K: The outcome and repair integrity of completely arthroscopically repaired large and massive rotator cuff tears. J Bone Joint Surg 2004;86-A:219-224.
    1. Lipner J, Shen H, Cavinatto L, et al. : In vivo evaluation of adipose-derived stromal cells delivered with a nanofiber scaffold for tendon-to-bone repair. Tissue Eng 2015;21:2766-2774.
    1. Gupta AK, Hug K, Berkoff DJ, et al. : Dermal tissue allograft for the repair of massive irreparable rotator cuff tears. Am J Sports Med 2012;40:141-147.
    1. Angeline ME, Ma R, Pascual-Garrido C, et al. : Effect of diet-induced vitamin D deficiency on rotator cuff healing in a rat model. Am J Sports Med 2014;42:27-34.
    1. Drincic AT, Armas LAG, Van Diest EE, Heaney RP: Volumetric dilution, rather than sequestration best explains the low vitamin D status of obesity. Obesity 2012;20:1444-1448.
    1. Anderson JL, May HT, Horne BD, et al. : Relation of vitamin D deficiency to cardiovascular risk factors, disease status, and incident events in a general healthcare population. Am J Cardiol 2010;106:963-968.
    1. Jost BYB, Pfirrmann CWA, Gerber C: Clinical outcome after structural failure of rotator cuff repairs. J Bone Joint Surg 2000;82-A:304-314.
    1. Jost B, Zumstein M, Pfirrmann CWA, Gerber C: Long-term outcome after structural failure of rotator cuff repairs. J Bone Joint Surg 2006;88-A:472-479.
    1. Lädermann A, Denard PJ, Burkhart SS: Management of failed rotator cuff repair: A systematic review. Br J Sports Med 2016;16:1-6.
    1. Russell RD, Knight JR, Mulligan E, Khazzam MS: Not correlate with patient function and pain. J Bone Joint Surg 2014;96:265-271.
    1. Lafosse BL, Jost B, Reiland Y: Structural integrity and clinical outcomes after arthroscopic repair of isolated subscapularis tears. J Bone Joint Surg 2007;89:1184-1193.
    1. Namdari S, Donegan RP, Chamberlain AM, Galatz LM, Yamaguchi K, Keener JD: Factors affecting outcome after structural failure of repaired rotator cuff tears. J Bone Joint Surg 2014;96:99-105.
    1. Uppal HS: Frozen shoulder: A systematic review of therapeutic options. World J Orthop 2015;6:263.
    1. Zerr P, Vollath S, Palumbo-Zerr K, et al. : Vitamin D receptor regulates TGF-β signalling in systemic sclerosis. Ann Rheum Dis 2015;74:1-8.
    1. Lee SA, Yang HW, Um JY, Shin JM, Park IH, Lee HM: Vitamin D attenuates myofibroblast differentiation and extracellular matrix accumulation in nasal polyp-derived fibroblasts through smad2/3 signaling pathway. Sci Rep 2017;7:1-12.
    1. Zreik NH, Malik RA, Charalambous CP: Adhesive capsulitis of the shoulder and diabetes: A meta-analysis of prevalence. Muscles Ligaments Tendons J 2016;6:26-34.
    1. Pons-Villanueva J, Escalada San Martín J: The stiff shoulder in diabetic patients. Int J Rheum Dis 2016;19:1226-1236.

Source: PubMed

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