Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 27, Issue 4, pp 1182–1188 | Cite as

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

  • Henrik BehrendEmail author
  • Harald Lengnick
  • Vilijam Zdravkovic
  • Andreas Ladurner
  • Diana Rudin
  • Matthias Erschbamer
  • Markus Joerger
  • Markus Kuster



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).


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.


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).


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


Trial registry

The study was registered at the ISRCTN registry with study ID ISRCTN40250576.


Vitamin C plasma levels Arthrofibrosis Forgotten Joint Score-12 Total Knee Arthroplasty (TKA) Total Knee Replacement (TKR) 



This study was funded by a special grant: “Entschädigung, Innovation und Entwicklung” of Cantonal Hospital St. Gallen number: 100111.

Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in the study were in accordance with the ethical standards of the international research committee and with the 1964 Helsinki declaration and its amendments or comparable ethical standards. The approval of the ethics committee of Canton St. Gallen: EKSG 10/098 was obtained.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2018

Authors and Affiliations

  1. 1.Department of Orthopaedic Surgery and TraumatologyCantonal Hospital, St. GallenSt. GallenSwitzerland
  2. 2.Department of Medical Oncology and HaematologyCantonal HospitalSt. GallenSwitzerland
  3. 3.Department of Orthopaedic Surgery, Royal Perth HospitalUniversity of Western AustraliaPerthAustralia

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