{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T05:18:08Z","timestamp":1787807888423,"version":"build-2784847793"},"reference-count":31,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T00:00:00Z","timestamp":1787788800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This hypothesis-generating study aimed to explore the association of preoperative serum 25-hydroxyvitamin D [25(OH)D] levels with deep vein thrombosis (DVT) risk after total knee arthroplasty (TKA) and clarify the potential coagulation-related mechanisms.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A total of 193 patients undergoing primary unilateral TKA in a single center were stratified into 25(OH)D deficiency (&amp;lt;20 ng\/mL,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009106), insufficiency (20\u201329 ng\/mL,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200947), and sufficiency (\u226530 ng\/mL,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200940) groups. Postoperative DVT (detected via day 5\u20137 venous ultrasonography) and coagulation indices [D-dimer, prothrombin time (PT)] were compared across groups. Univariate and multivariate logistic regression were used to screen DVT-related factors, and Firth's penalized logistic regression was applied for a sparse-data sensitivity analysis.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The overall postoperative DVT incidence was 13.5% (26\/193). A bivariate analysis revealed a markedly higher DVT rate in the deficiency group (18.9%) than in the sufficiency group (2.5%), with a crude 2\u2009\u00d7\u20092 odds ratio (OR) of 9.070 [95% confidence interval (CI): 1.198\u201368.542,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.015]; this estimate was unstable due to only one DVT case in the sufficiency group. To provide a more stable estimate, a secondary binary logistic regression model (deficiency vs. non-deficiency) was performed, which identified preoperative 25(OH)D deficiency as significantly correlated with postoperative DVT (OR\u2009=\u20093.140, 95% CI: 1.200\u20138.212,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.020). After analysis of covariance adjustment for baseline levels, the deficiency group maintained significantly higher postoperative D-dimer and shorter PT than the sufficiency group (both\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001). A univariate analysis identified 25(OH)D deficiency and elevated postoperative D-dimer as DVT-related risk factors. In the secondary exploratory model adjusting for postoperative D-dimer (a potential mediator), the association between vitamin D deficiency and DVT was attenuated (OR\u2009=\u20092.576, 95% CI: 0.941\u20137.049,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.065), indicating a possible mediating effect rather than confounding bias. Firth's sensitivity analysis on the binary model further verified the robustness of this finding (OR\u2009=\u20092.918, 95% CI: 1.142\u20137.456,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.025).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Preoperative 25(OH)D deficiency is associated with elevated postoperative DVT risk after TKA in univariate analyses. Abnormal postoperative D-dimer and PT levels suggest that vitamin D status may modulate coagulation-fibrinolysis balance. The attenuated association after D-dimer adjustment supports a potential mediating mechanism. As a hypothesis-generating analysis, these preliminary findings require further validation in large-scale prospective studies to confirm the independent predictive value of preoperative vitamin D deficiency for post-TKA DVT.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fsurg.2026.1756540","type":"journal-article","created":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T04:26:57Z","timestamp":1787804817000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Association of preoperative serum 25-hydroxyvitamin D levels with deep vein thrombosis after total knee arthroplasty: a hypothesis-generating analysis of coagulation function mechanisms"],"prefix":"10.3389","volume":"13","author":[{"given":"He","family":"Shang","sequence":"first","affiliation":[{"name":"Third Clinical Medical College of Ningxia Medical University, People\u2019s Hospital of Ningxia Hui Autonomous Region","place":["Yinchuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun","family":"Li","sequence":"additional","affiliation":[{"name":"Third Clinical Medical College of Ningxia Medical University, People\u2019s Hospital of Ningxia Hui Autonomous Region","place":["Yinchuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tao","family":"Ma","sequence":"additional","affiliation":[{"name":"Department of Joint Surgery, Ningxia Hui Autonomous Region People\u2019s Hospital (Affiliated Hospital of Ningxia Medical University)","place":["Yinchuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuan","family":"Wei","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Affiliated Hospital of Xuzhou Medical University","place":["Xuzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jinpeng","family":"Liang","sequence":"additional","affiliation":[{"name":"Department of Joint Surgery, Ningxia Hui Autonomous Region People\u2019s Hospital (Affiliated Hospital of Ningxia Medical University)","place":["Yinchuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yumei","family":"Ding","sequence":"additional","affiliation":[{"name":"Third Clinical Medical College of Ningxia Medical University, People\u2019s Hospital of Ningxia Hui Autonomous Region","place":["Yinchuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xing","family":"He","sequence":"additional","affiliation":[{"name":"Third Clinical Medical College of Ningxia Medical University, People\u2019s Hospital of Ningxia Hui Autonomous Region","place":["Yinchuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Biao","family":"Ma","sequence":"additional","affiliation":[{"name":"Third Clinical Medical College of Ningxia Medical University, People\u2019s Hospital of Ningxia Hui Autonomous Region","place":["Yinchuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yaxing","family":"Ma","sequence":"additional","affiliation":[{"name":"Third Clinical Medical College of Ningxia Medical University, People\u2019s Hospital of Ningxia Hui Autonomous Region","place":["Yinchuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruoyu","family":"Wang","sequence":"additional","affiliation":[{"name":"Third Clinical Medical College of Ningxia Medical University, People\u2019s Hospital of Ningxia Hui Autonomous Region","place":["Yinchuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Joint Surgery, Ningxia Hui Autonomous Region People\u2019s Hospital (Affiliated Hospital of Ningxia Medical University)","place":["Yinchuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Desheng","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Joint Surgery, Ningxia Hui Autonomous Region People\u2019s Hospital (Affiliated Hospital of Ningxia Medical University)","place":["Yinchuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,27]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1186\/s43019-025-00273-6","article-title":"Thromboembolic and infectious complication risks in TKA and UKA: evidence from a Japanese nationwide cohort","volume":"37","author":"Mori","year":"2025","journal-title":"Knee Surg Relat Res"},{"key":"B2","doi-asserted-by":"publisher","first-page":"3417648","DOI":"10.1155\/2018\/3417648","article-title":"Preoperative evaluation of soleal vein diameter by ultrasound is beneficial for prophylaxis of deep vein thrombosis after total knee or hip arthroplasty","volume":"2018","author":"Yao","year":"2018","journal-title":"BioMed Res Int"},{"key":"B3","doi-asserted-by":"publisher","first-page":"126","DOI":"10.1097\/MBC.0000000000000556","article-title":"Incidence and risk factors of deep vein thrombosis (DVT) after total hip or knee arthroplasty: a retrospective study with routinely applied venography","volume":"28","author":"Zhang","year":"2017","journal-title":"Blood Coagul Fibrinolysis"},{"key":"B4","doi-asserted-by":"publisher","first-page":"2161","DOI":"10.1056\/NEJMoa2113194","article-title":"Milvexian for the prevention of venous thromboembolism","volume":"385","author":"Weitz","year":"2021","journal-title":"N Engl J Med"},{"key":"B5","doi-asserted-by":"publisher","first-page":"1185","DOI":"10.1016\/j.amjmed.2025.03.020","article-title":"Aspirin for venous thromboembolism prophylaxis in hip fracture, total knee, and hip arthroplasty","volume":"138","author":"Leyva","year":"2025","journal-title":"Am J Med"},{"key":"B6","doi-asserted-by":"publisher","first-page":"767","DOI":"10.1186\/s12891-022-05712-z","article-title":"The application of caprini risk assessment model in evaluation of deep vein thrombosis for patients with end-stage osteoarthritis before arthroplasty","volume":"23","author":"Sun","year":"2022","journal-title":"BMC Musculoskelet Disord"},{"key":"B7","doi-asserted-by":"publisher","first-page":"3991","DOI":"10.3390\/nu16233991","article-title":"Prevalence and associated risk factors for hypovitaminosis D in patients scheduled for primary total knee arthroplasty in Germany","volume":"16","author":"Heinz","year":"2024","journal-title":"Nutrients"},{"key":"B8","doi-asserted-by":"publisher","first-page":"90","DOI":"10.3390\/nu17010090","article-title":"Recent updates and advances in the association between vitamin D deficiency and risk of thrombotic disease","volume":"17","author":"Ojaroodi","year":"2024","journal-title":"Nutrients"},{"key":"B9","doi-asserted-by":"publisher","first-page":"1639257","DOI":"10.3389\/fnut.2025.1639257","article-title":"Association between vitamin D deficiency and risk of venous thromboembolism: a matched cohort study of 139,690 patients","volume":"12","author":"Hung","year":"2025","journal-title":"Front Nutr"},{"key":"B10","doi-asserted-by":"publisher","first-page":"453","DOI":"10.1055\/s-0042-1756701","article-title":"Is vitamin D deficiency prothrombotic? A systematic review","volume":"49","author":"R\u00fcdiger","year":"2023","journal-title":"Semin Thromb Hemost"},{"key":"B11","doi-asserted-by":"publisher","first-page":"40","DOI":"10.1002\/jcph.774","article-title":"The effect of treatment of vitamin D deficiency on the level of P-selectin and hs-CRP in patients with thromboembolism: a pilot randomized clinical trial","volume":"57","author":"Hejazi","year":"2017","journal-title":"J Clin Pharmacol"},{"key":"B12","doi-asserted-by":"publisher","first-page":"50","DOI":"10.1093\/bmb\/ldaa018","article-title":"Outcome of total hip and total knee arthroplasty and vitamin D homeostasis","volume":"135","author":"Brambilla","year":"2020","journal-title":"Br Med Bull"},{"key":"B13","doi-asserted-by":"publisher","first-page":"e70014","DOI":"10.1002\/dmrr.70014","article-title":"Relationship of serum 25-hydroxyvitamin D concentrations, diabetes, vitamin D receptor gene polymorphisms and incident venous thromboembolism","volume":"41","author":"Xiang","year":"2025","journal-title":"Diabetes Metab Res Rev"},{"key":"B14","doi-asserted-by":"publisher","first-page":"1379","DOI":"10.1016\/j.arth.2019.12.037","article-title":"Preoperative vitamin D repletion in total knee arthroplasty: a cost-effectiveness model","volume":"35","author":"Arshi","year":"2020","journal-title":"J Arthroplasty"},{"key":"B15","doi-asserted-by":"publisher","first-page":"496","DOI":"10.1186\/s13018-020-02020-x","article-title":"Predictive value of preoperative erythrocyte electrophoresis exponent for acute deep vein thrombosis after total knee arthroplasty in patients with knee osteoarthritis","volume":"15","author":"Xiaoyu","year":"2020","journal-title":"J Orthop Surg Res"},{"key":"B16","doi-asserted-by":"publisher","first-page":"1911","DOI":"10.1210\/jc.2011-0385","article-title":"Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline","volume":"96","author":"Holick","year":"2011","journal-title":"J Clin Endocrinol Metab"},{"key":"B17","doi-asserted-by":"publisher","first-page":"1907","DOI":"10.1210\/clinem\/dgae290","article-title":"Vitamin D for the prevention of disease: an Endocrine Society Clinical Practice guideline","volume":"109","author":"Demay","year":"2024","journal-title":"J Clin Endocrinol Metab"},{"key":"B18","doi-asserted-by":"publisher","first-page":"1639257","DOI":"10.3389\/fnut.2025.1639257","article-title":"Association between vitamin D deficiency and risk of venous thromboembolism: a matched cohort study of 139,690 patients","volume":"12","author":"Hung","year":"2025","journal-title":"Front Nutr"},{"key":"B19","doi-asserted-by":"publisher","first-page":"1113","DOI":"10.3390\/nu15051113","article-title":"Is circulating vitamin D status associated with the risk of venous thromboembolism? a meta-analysis of observational studies","volume":"15","author":"Hung","year":"2023","journal-title":"Nutrients"},{"key":"B20","doi-asserted-by":"publisher","first-page":"279","DOI":"10.1590\/1516-3180.2020.0457.R1.04022021","article-title":"Association between vitamin D levels and lower-extremity deep vein thrombosis: a case-control study","volume":"139","author":"Korkmaz","year":"2021","journal-title":"Sao Paulo Med J"},{"key":"B21","doi-asserted-by":"publisher","first-page":"339","DOI":"10.31083\/j.rcm.2020.03.131","article-title":"Vitamin D deficiency in association with endothelial dysfunction: implications for patients with COVID-19","volume":"21","author":"Zhang","year":"2020","journal-title":"Rev Cardiovasc Med"},{"key":"B22","doi-asserted-by":"publisher","first-page":"948","DOI":"10.3390\/antiox12040948","article-title":"Vitamin D determinants, status, and antioxidant\/anti-inflammatory-related effects in cardiovascular risk and disease: not the last word in the controversy","volume":"12","author":"Della Nera","year":"2023","journal-title":"Antioxidants"},{"key":"B23","doi-asserted-by":"publisher","first-page":"303","DOI":"10.2147\/IJGM.S64812","article-title":"The relationship between vitamin D status and idiopathic lower-extremity deep vein thrombosis","volume":"7","author":"Khademvatani","year":"2014","journal-title":"Int J Gen Med"},{"key":"B24","doi-asserted-by":"publisher","first-page":"64","DOI":"10.1186\/s13104-024-06721-y","article-title":"Investigation of serum level relationship of pro-inflammatory and anti-inflammatory cytokines with vitamin D among healthy Ghanaian population","volume":"17","author":"Antwi","year":"2024","journal-title":"BMC Res Notes"},{"key":"B25","doi-asserted-by":"publisher","first-page":"69S","DOI":"10.1177\/1076029618786574","article-title":"Low vitamin D levels are associated with the development of deep venous thromboembolic events in patients with ischemic stroke","volume":"24","author":"Wu","year":"2018","journal-title":"Clin Appl Thromb Hemost"},{"key":"B26","doi-asserted-by":"publisher","first-page":"40","DOI":"10.1002\/jcph.774","article-title":"The effect of treatment of vitamin D deficiency on the level of P-selectin and hs-CRP in patients with thromboembolism: a pilot randomized clinical trial","volume":"57","author":"Hejazi","year":"2017","journal-title":"J Clin Pharmacol"},{"key":"B27","doi-asserted-by":"publisher","first-page":"e1051","DOI":"10.1161\/CIR.0000000000001330","article-title":"Revisiting the open vein hypothesis to reduce the postthrombotic syndrome: implications for multidisciplinary care and research: a scientific statement from the American Heart Association","volume":"151","author":"Li","year":"2025","journal-title":"Circulation"},{"key":"B28","doi-asserted-by":"publisher","first-page":"804","DOI":"10.1093\/nutrit\/nuac091","article-title":"Vitamin D deficiency in nursing home residents: a systematic review","volume":"81","author":"Feehan","year":"2023","journal-title":"Nutr Rev"},{"key":"B29","doi-asserted-by":"publisher","first-page":"e043972","DOI":"10.1161\/JAHA.125.043972","article-title":"Genetic downregulation of interleukin-6 signaling, coagulation function, and risk of thromboembolic disease","volume":"14","author":"Daghlas","year":"2025","journal-title":"J Am Heart Assoc"},{"key":"B30","doi-asserted-by":"publisher","first-page":"1032","DOI":"10.1093\/jjco\/hyae064","article-title":"D-dimer cut-off value for predicting venous thromboembolism at the initial diagnosis in Japanese patients with advanced lung cancer","volume":"54","author":"Kawakado","year":"2024","journal-title":"Jpn J Clin Oncol"},{"key":"B31","doi-asserted-by":"publisher","first-page":"384","DOI":"10.3389\/fneur.2020.00384","article-title":"Vitamin D and stroke: effects on incidence, severity, and outcome and the potential benefits of supplementation","volume":"11","author":"Yarlagadda","year":"2020","journal-title":"Front Neurol"}],"container-title":["Frontiers in Surgery"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2026.1756540\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T04:26:58Z","timestamp":1787804818000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2026.1756540\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,27]]},"references-count":31,"alternative-id":["10.3389\/fsurg.2026.1756540"],"URL":"https:\/\/doi.org\/10.3389\/fsurg.2026.1756540","relation":{},"ISSN":["2296-875X"],"issn-type":[{"value":"2296-875X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,27]]},"article-number":"1756540"}}