Vitamin D deficiency is associated with adverse medical outcomes following total shoulder arthroplasty

Vitamin D deficiency, or hypovitaminosis D, is linked to poor surgical outcomes. Its effect on total shoulder arthroplasty (TSA) remains unclear. This study assesses the association between vitamin D deficiency and postoperative complications following TSA.

Following propensity score matching for demographics and comorbidities, a retrospective cohort of 6892 TSA patients from 95 institutions was analyzed, with 3446 patients in each group (vitamin D deficient and nondeficient). Complications were evaluated at 90 days, 1 year, and 2 years post-TSA, including acute kidney failure (AKF), myocardial infarction, deep vein thrombosis (DVT), pulmonary embolism (PE), pneumonia, mechanical ventilation, wound dehiscence, sepsis, various infections (deep, superficial, and prosthetic), revision surgery, aseptic loosening, prosthesis dislocation, periprosthetic fractures, readmission, and mortality.

Vitamin D deficiency was associated with higher rates of AKF, DVT, PE, pneumonia, and periprosthetic fractures at 90 days, with similar trends persisting at 1 year, except for PE. Additionally, readmission rates were significantly higher in the vitamin D-deficient cohort at 1 year. At 2 years, AKF, DVT, pneumonia, and readmission continued to be significantly associated with vitamin D deficiency, while periprosthetic fractures did not show a significant difference between the cohorts.

Orthopedic surgeons should recognize vitamin D deficiency as a potential modifiable risk factor for postoperative complications in TSA. The observed association between vitamin D deficiency and increased rates of readmission and periprosthetic fractures suggests that addressing vitamin D levels may be linked to reduced future healthcare utilization. While correcting vitamin D deficiency preoperatively may be associated with a reduction in the risk of medical complications and improvement in patient outcomes following TSA, further research is needed to better understand the nature of these relationships.