Beswick Andrew David, Wylde Vikki, Gooberman-Hill Rachael, Blom Ashley, Dieppe Paul
School of Clinical Sciences, University of Bristol, Bristol, UK.
BMJ Open. 2012 Feb 22;2(1):e000435. doi: 10.1136/bmjopen-2011-000435. Print 2012.
Total hip or knee replacement is highly successful when judged by prosthesis-related outcomes. However, some people experience long-term pain.
To review published studies in representative populations with total hip or knee replacement for the treatment of osteoarthritis reporting proportions of people by pain intensity.
MEDLINE and EMBASE databases searched to January 2011 with no language restrictions. Citations of key articles in ISI Web of Science and reference lists were checked.
STUDY ELIGIBILITY CRITERIA, PARTICIPANTS AND INTERVENTIONS: Prospective studies of consecutive, unselected osteoarthritis patients representative of the primary total hip or knee replacement population, with intensities of patient-centred pain measured after 3 months to 5-year follow-up.
Two authors screened titles and abstracts. Data extracted by one author were checked independently against original articles by a second. For each study, the authors summarised the proportions of people with different severities of pain in the operated joint.
Searches identified 1308 articles of which 115 reported patient-centred pain outcomes. Fourteen articles describing 17 cohorts (6 with hip and 11 with knee replacement) presented appropriate data on pain intensity. The proportion of people with an unfavourable long-term pain outcome in studies ranged from about 7% to 23% after hip and 10% to 34% after knee replacement. In the best quality studies, an unfavourable pain outcome was reported in 9% or more of patients after hip and about 20% of patients after knee replacement.
Other studies reported mean values of pain outcomes. These and routine clinical studies are potential sources of relevant data.
After hip and knee replacement, a significant proportion of people have painful joints. There is an urgent need to improve general awareness of this possibility and to address determinants of good and bad outcomes.
从假体相关结局来看，全髋关节或膝关节置换术非常成功。然而，有些人会经历长期疼痛。
回顾已发表的关于代表性人群接受全髋关节或膝关节置换术治疗骨关节炎的研究，报告不同疼痛强度人群的比例。
检索MEDLINE和EMBASE数据库至2011年1月，无语言限制。检查了ISI科学网中关键文章的引用情况以及参考文献列表。
研究入选标准、参与者和干预措施：对连续的、未经选择的骨关节炎患者进行前瞻性研究，这些患者代表初次全髋关节或膝关节置换人群，在3个月至5年随访后测量以患者为中心的疼痛强度。
两位作者筛选标题和摘要。由一位作者提取的数据由另一位作者对照原始文章独立检查。对于每项研究，作者总结了手术关节中不同疼痛严重程度人群的比例。
检索到1308篇文章，其中115篇报告了以患者为中心的疼痛结局。14篇文章描述了17个队列（6个髋关节置换队列和11个膝关节置换队列）提供了关于疼痛强度的合适数据。研究中，髋关节置换术后长期疼痛结局不佳的人群比例约为7%至23%，膝关节置换术后为10%至34%。在质量最佳的研究中，髋关节置换术后9%或更多患者以及膝关节置换术后约20%患者报告了不良疼痛结局。
其他研究报告了疼痛结局的平均值。这些研究和常规临床研究是相关数据的潜在来源。
髋关节和膝关节置换术后，相当一部分人存在关节疼痛。迫切需要提高对此可能性的普遍认识，并解决良好和不良结局的决定因素。
