Abstract
BACKGROUND: The perioperative efficacy of vitamin C (VC) supplementation in total hip and knee arthroplasty (THA/TKA) remains underexplored. This systematic review and meta-analysis comprehensively evaluated, for the first time, the impact of VC on perioperative outcomes in THA/TKA. METHODS: In accordance with the PRISMA guidelines and prospectively registered with PROSPERO, we searched PubMed, Web of Science, Embase, and the Cochrane Library databases up to April 30, 2025. Two independent investigators performed literature screening, data extraction, and Cochrane risk-of-bias assessments. Meta-analyses were conducted using RevMan 5.4 software, and qualitative synthesis was applied where appropriate. RESULTS: Eight RCTs involving 852 patients were included. Meta-analysis revealed that, compared to controls, VC supplementation significantly reduced postoperative 24-hour visual analog scale (VAS) scores (MD = -0.60, 95% CI -1.14 to -0.07), C-reactive protein (CRP) levels (MD = -14.88, 95% CI -16.84 to -12.92), and interleukin-6 (IL-6) levels (MD = -9.17, 95% CI -12.94 to -5.41). However, no significant differences were observed in these outcomes at 48 h postoperatively (P > 0.05). Qualitative analysis suggested that perioperative VC supplementation may decrease the risk of complex regional pain syndrome (CRPS) and bleeding, reduce propofol dosage, lower the incidence of nausea, and potentially protect against cardiac issues and arthrofibrosis development. CONCLUSION: Perioperative VC supplementation for THA/TKA may alleviate pain and reduce inflammatory responses within 24 h. Large-scale, high-quality RCTs employing standardized VC protocols are required in the future to establish reliable evidence-based foundations for clinical implementation. TRIAL REGISTRATION: This study was prospectively registered in the PROSPERO database (registration number: CRD42025633608) on January 17, 2025. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12891-025-09163-0.