Vitamin C demand is increased after total knee arthroplasty: a double-blind placebo-controlled-randomized study

Henrik Behrend, Harald Lengnick, Vilijam Zdravkovic, Andreas Ladurner, Diana Rudin, Matthias Erschbamer, Markus Joerger, Markus Kuster

Research output: Contribution to journalArticlepeer-review

11 Citations (Scopus)


Purpose: This study was designed to determine whether perioperative supplementation of vitamin C (VC) improves range of motion (ROM) and reduces the risk of arthrofibrosis (AF) following total knee arthroplasty (TKA). Methods: Ninety-five patients undergoing TKA were randomized to either oral VC (1000 mg daily) or placebo for 50 days (48 VC group, 47 placebo group). The effect of VC supplementation was tested on ROM, AF, WOMAC, FJS-12, and VC plasma concentrations (VCc). VCc were analyzed in both patient groups before surgery, 4 and 7 days after surgery. Results: ROM at 1 year was not different between study groups. The prevalence of AF was 5 of 48 (10.4%) in the VC group compared to 11 of 47 (23.4%) in the placebo group (p = 0.09). VCc decreased post-operatively in the placebo group (49–12 µmol/l on day 7, p < 0.001), but not in the VC group (53–57 µmol/l). Patients with a perioperative drop of VCc ≥ 30 µmol/l developed significantly more AF at 1 year compared to patients with a VCc drop of < 30 µmol/l (p = 0.007). Conclusions: TKA results in VC depletion. Perioperative VC supplementation prevents VCc drop in most patients undergoing TKA and may lower the incidence of AF. The clinical relevance of this study is that VC supplementation seems to be a cheap and safe adjunct to improve functional outcome after TKA. Level of evidence: I. Trial registry: The study was registered at the ISRCTN registry with study ID ISRCTN40250576.

Original languageEnglish
Pages (from-to)1182-1188
Number of pages7
JournalKnee Surgery, Sports Traumatology, Arthroscopy
Issue number4
Early online date28 Jun 2018
Publication statusPublished - 5 Apr 2019


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