title: Is there an association between periprosthetic joint infection and low vitamin D levels?
abstract: OBJECTIVE
  Vitamin D is increasingly being recognized as an important mediator of immune function and may have a preventive role in the pathogenesis of periprosthetic joint infection. To the best of our knowledge, no other study has examined possible associations between periprosthetic joint infection and vitamin D deficiency. We investigated the rate of vitamin D deficiency in patients treated for periprosthetic joint infection and whether vitamin D deficiency is independent of other risk factors for vitamin D deficiency in patients with periprosthetic joint infection.
  
  
  METHODS
  Serum 25-hydroxyvitamin D (25OHD) levels of every patient scheduled to receive a total prosthesis either of the hip, knee, or shoulder in the orthopaedic department of the Johannes-Guttenberg-University Hospital in Mainz, Germany (109 patients), were measured after admission. Furthermore, serum 25OHD levels were measured for every patient presenting with periprosthetic joint infection (n = 50) or aseptic loosening of the prosthesis (n = 31) scheduled to undergo revision surgery. The prevalence of normal (> 30 ng/ml), insufficient (20-30 ng/ml), and deficient (<20 ng/ml) 25OHD levels was determined.
  
  
  RESULTS
  All tested patient subgroups showed low vitamin D levels. Statistical analysis found no significant difference in vitamin D levels comparing patients with prosthesis and patients with aseptic prosthesis loosening (p = 0.58). Significant differences in 25OHD levels were found comparing patients with periprosthetic joint infection and patients scheduled for primary arthroplasty (p < 0.001). In addition, we found a significant difference (p < 0,001) in 25OHD levels of patients with periprosthetic joint infection compared with patients with aseptic prosthesis loosening.
  
  
  CONCLUSIONS
  We found a high frequency of vitamin D deficiency in patients being treated by primary arthroplasty and those with aseptic joint prosthetic loosening and periprosthetic joint infection. Vitamin D deficiency was severe in patients with periprosthetic joint infection.
authors.affiliation: Department of Trauma Surgery, Justus-Liebig-University, Giessen, Germany, gerrit.s.maier@gmx.de.
authors.forename: Gerrit Steffen
authors.initials: GS
authors.lastname: Maier
authors.forename: Konstantin
authors.initials: K
authors.lastname: Horas
authors.forename: Jörn Bengt
authors.initials: JB
authors.lastname: Seeger
authors.forename: Klaus Edgar
authors.initials: KE
authors.lastname: Roth
authors.forename: Andreas Alois
authors.initials: AA
authors.lastname: Kurth
authors.forename: Uwe
authors.initials: U
authors.lastname: Maus
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019643:Arthroplasty, Replacement / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011475:Prosthesis Failure; D016459:Prosthesis-Related Infections / Q000097:blood / Q000209:etiology*; D012086:Reoperation; D012307:Risk Factors; D014807:Vitamin D / Q000031:analogs & derivatives / Q000097:blood; D014808:Vitamin D Deficiency / Q000097:blood / Q000150:complications*
chemical_list: D014807:Vitamin D; C104450:25-hydroxyvitamin D
references.citation: J Orthop Trauma. 2013 May;27(5):e103-6
references.pmid: 22576645
references.citation: Altern Med Rev. 2008 Mar;13(1):6-20
references.pmid: 18377099
references.citation: Arch Intern Med. 2009 Feb 23;169(4):384-90
references.pmid: 19237723
references.citation: Klin Wochenschr. 1977 May 15;55(10):507-8
references.pmid: 195120
references.citation: J Bone Joint Surg Am. 2010 Oct 6;92(13):2300-4
references.pmid: 20926724
references.citation: Dermatoendocrinol. 2011 Oct;3(4):220-9
references.pmid: 22259647
references.citation: J Bone Joint Surg Am. 2012 Jul 18;94(14):e104
references.pmid: 22810411
references.citation: Interdiscip Perspect Infect Dis. 2013;2013:542796
references.pmid: 24023542
references.citation: J Steroid Biochem Mol Biol. 2005 Oct;97(1-2):93-101
references.pmid: 16046118
references.citation: Br J Nutr. 2013 Jan 14;109(1):99-102
references.pmid: 22715859
references.citation: Int J Med Sci. 2007 Jul 10;4(4):190-5
references.pmid: 17657282
references.citation: Acta Orthop Belg. 2013 Oct;79(5):587-91
references.pmid: 24350523
references.citation: Endocrinol Metab Clin North Am. 2010 Jun;39(2):365-79, table of contents
references.pmid: 20511058
references.citation: Science. 2006 Mar 24;311(5768):1770-3
references.pmid: 16497887
references.citation: Clin Orthop Relat Res. 2013 Sep;471(9):3029-35
references.pmid: 23609810
references.citation: Clin Exp Immunol. 2006 Jan;143(1):58-64
references.pmid: 16367934
references.citation: Am J Clin Nutr. 2010 May;91(5):1255-60
references.pmid: 20219962
references.citation: Clin Orthop Relat Res. 2008 Jul;466(7):1710-5
references.pmid: 18421542
references.citation: Can J Surg. 2012 Dec;55(6):394-400
references.pmid: 22992404
references.citation: N Engl J Med. 2007 Jul 19;357(3):266-81
references.pmid: 17634462
references.citation: Clin Orthop Relat Res. 2008 Jun;466(6):1368-71
references.pmid: 18404297
references.citation: Acad Emerg Med. 2011 May;18(5):551-4
references.pmid: 21518095
references.citation: J Immunol. 2007 Aug 15;179(4):2060-3
references.pmid: 17675463
references.citation: J Steroid Biochem Mol Biol. 2004 May;89-90(1-5):457-9
references.pmid: 15225820
references.citation: J Arthroplasty. 2005 Oct;20(7 Suppl 3):46-50
references.pmid: 16214002
references.citation: J Arthroplasty. 2007 Aug;22(5):651-6
references.pmid: 17689771