High Dose Vitamin D Supplementation Can Correct Hypovitaminosis D Prior to Total Knee Arthroplasty.

BACKGROUND Vitamin D deficiency in the perioperative surgical period is associated with inferior surgical outcomes. There are no established preoperative supplementation regimens in the orthopaedic literature. The purpose of this study was to compare the efficacy between two different supplementation regimens of vitamin D prior to total knee arthroplasty (TKA). METHODS We conducted a retrospective analysis of 174 patients identified as vitamin D-deficient (25(OH)D <30 ng/mL) who received one of two vitamin D supplementation protocols: (1) daily supplementation with D3 on a sliding scale from 1,000 IU to 6,000 IU, or (2) a loading dose of 50,000 IU D3 weekly for 4 weeks then 2,000 IU per day. Serum vitamin D levels were measured at 3 months and 1 month preoperatively. RESULTS Mean patient age was 65.5(±8.6) years, and 54.6% were female. Deficiency was corrected in 73.3% of patients in the loading dose group and 42.4% of patients in the daily, low dose group [Chi-squared (1, N = 174) = 16.53, p < 0.001]. Patients in the loading dose group also achieved a greater average correction in vitamin D levels. CONCLUSION This is the first study to compare preoperative vitamin D supplementation protocols. A loading-dose regimen of 50,000 IU weekly for 4 weeks followed by a maintenance dose of 2,000 IU per day more effectively corrects vitamin D deficiency compared to a low-dose, daily regimen among TKA patients. We recommend this regimen for deficiency correction in patients that have been screened to be deficient in vitamin D preoperatively.