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Incidence of hypomagnesemia based on ionized and total serum magnesium in patients undergoing revision total hip arthroplasty: A retrospective cohort study

Jiwon Han, Hyo-Seok Na, Haesun Jung, and Hyun-Jung Shin

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Volume 42 (2025) p. 25 - 30

Abstract

Trace Elements and Electrolytes, Vol. 42 – No. 1/2025 (25-30)

Incidence of hypomagnesemia based on ionized and total serum magnesium in patients undergoing revision total hip arthroplasty: A retrospective cohort study

Jiwon Han¹#², Hyo-Seok Na³#⁴, Haesun Jung¹, and Hyun-Jung Shin³#⁴

¹Department of Anesthesiology and Pain Medicine, Chung-Ang University College of Medicine, ²Institute of Clinical Medicine, Chung-Ang University Gwangmyeong Hospital, ³Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, and ⁴Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, South Korea
Objective: Magnesium is an essential element for bone health. Magnesium deficiency can significantly affect the prognosis of total hip arthroplasty (THA) owing to its influence on bone density. Magnesium status is usually determined by measuring total serum magnesium levels; however, the biologically active form is ionized magnesium. This study investigated the incidence of hypomagnesemia based on serum ionized and total magnesium levels.
Materials and methods: We retrospectively reviewed the medical records of 356 patients who underwent revision THA between January 2012 and June 2023. The incidence of hypomagnesemia was compared according to two definitions: ionized magnesium < 0.45 mmol/L and total magnesium < 0.62 mmol/L. Additionally, we analyzed the correlation between ionized and total magnesium levels, other laboratory parameters (glomerular filtration rate, albumin, 25-hydroxy vitamin D3, and parathyroid hormone levels), and the length of hospital stay.
Results: Of the patients who underwent total hip arthroplasty during the study period, 126 were excluded, and the data of the remaining 230 patients were included in the analysis. The incidence of hypomagnesemia based on ionized magnesium levels was 17.4%, whereas no hypomagnesemia was observed when classified according to total magnesium levels (p < 0.001). Furthermore, the ionized and total magnesium levels were not significantly correlated (r = 0.271, p = 0.001). There were no laboratory parameters related to serum magnesium level. Although the difference was not significant, the length of the hospital stay increased as ionized magnesium levels decreased.
Conclusion: The incidence of hypomagnesemia was significantly higher when the ionized magnesium level was used than the total magnesium level, with no correlation observed between the ionized and total magnesium levels.Correspondence to:
Prof. Hyun-Jung Shin, MD, PhD
Department of Anesthesiology and Pain Medicine
Seoul National University Bundang Hospital
Gumi-ro 173 Beongil, Bundang-gu,
Seongnam 13620, South Korea
Email: [email protected]

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