Vitamin C intake after total knee arthroplasty may lower complex regional pain syndrome

A recent study conducted by Jacques and team showed that consuming 1 gram of vitamin C daily for 40 days post total knee arthroplasty (TKA) may decrease pain occurrence and lower the risk of complex regional pain syndrome (CRPS). The findings were published in International Orthopaedics.

The research involved 469 participants, comprising 168 men and 301 women, with an average age of 68.6 years (ranging from 40 to 93 years). The population was divided into two groups: one eligible for randomization, consisting of 292 patients who underwent surgery between January 2018 and July 2019, and a historical group of 177 individuals who had surgery between January 2016 and December 2017.

The prospective analysis compared 153 participants in the vitamin C group with 139 participants in the control group, while retrospective analysis was applied to assess the 177 individuals in the historical group. All participants underwent the same surgical technique performed by one of three surgeons, each with over 5 years of experience using the identical approach. Uniform TKA implants, incisions, and post-operative protocols were employed for all participants. Evaluation occurred at consistent post-operative intervals: at 12 days, 3 months, 6 months, and annually thereafter.

The study revealed that patients in the prospective arm who ingested 1 gram of vitamin C daily for 40 days post-surgery experienced a significantly lower CRPS rate compared to those who did not take vitamin C (P = 0.008).

In the vitamin C group, the CRPS incidence was 3.9% (6/153), while the placebo group had an incidence of 12.2% (17/139). The historical group exhibited a CRPS prevalence of 13% (23/177).

The overall CRPS incidence for the entire prospective cohort was 7.9% (23/292).

Multivariate regression confirmed vitamin C as an independent preventive factor for CRPS, showing significant differences between the vitamin C and placebo groups, as well as between the vitamin C group and the historical group.

The number of knee replacement surgeries is projected to rise by 143% from 2012 to 2050. It is suggested that taking vitamin C for 40 days post-surgery is a straightforward recommendation due to the affordability, easy accessibility over the counter, and infrequent occurrence of side effects associated with vitamin C.

Reference:

Jacques, H., Jérôme, V., Antoine, C., Lucile, S., Valérie, D., Amandine, L., Theofylaktos, K., & Olivier, B. (2021). Prospective randomized study of the vitamin C effect on pain and complex pain regional syndrome after total knee arthroplasty. International Orthopaedics, 45(5), 1155–1162. https://doi.org/10.1007/s00264-020-04936-9