全膝关节置换术后股骨骨密度的变化：系统评价和荟萃分析。
Changes in femoral bone mineral density after total knee arthroplasty: a systematic review and meta-analysis.
机构信息
Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health, UWMF Centennial Building, 1685 Highland Avenue, 6th Floor, Madison, WI, 53705, USA.
University of Wisconsin Osteoporosis Clinical Research Program, Madison, WI, 53705, USA.
出版信息
Arch Osteoporos. 2019 Feb 23;14(1):23. doi: 10.1007/s11657-019-0572-7.
BACKGROUND
Bone loss after total knee arthroplasty (TKA) may lead to periprosthetic fractures that are associated with significant costs (morbidity, economic, etc.) and pose a challenge to operative fixation. This meta-analysis quantifies the change in bone mineral density (BMD) of the distal femur after primary TKA.
METHODS
A systematic review of six databases was performed by two independent reviewers. Studies that reported bone density after knee arthroplasty were identified and inclusion/exclusion criteria was applied. Data were extracted and analyzed using the Comprehensive Meta-Analysis Software.
RESULTS
Fourteen studies were included in the analysis. The average decrease in BMD was 0.09 [0.05, 0.13], 0.14 [0.08, 0.20], 0.16 [0.10, 0.23], and 0.16 [0.12, 0.20] g/cm at 3, 6, 12, and 24 months, respectively, corresponding to a 9.3%, 13.2%, 15.8%, and 15.4% BMD loss. A high degree of heterogeneity existed between the studies (I > 90% at most time points).
CONCLUSION
In summary, there is a rapid and significant 15% decrease in BMD in the first 6 months after TKA that is sustained to 24 months. Better understanding regarding how perioperative optimization of bone health may affect BMD loss and the incidence of periprosthetic fracture is essential.
LEVEL OF EVIDENCE
Therapeutic Level II.
背景
全膝关节置换术后（TKA）可能导致骨丢失，这与重大成本（发病率、经济等）相关，并对手术固定构成挑战。本荟萃分析定量评估了初次 TKA 后股骨远端骨密度（BMD）的变化。
方法
两名独立评审员对六个数据库进行了系统审查。确定了报告膝关节置换术后骨密度的研究，并应用了纳入/排除标准。使用 Comprehensive Meta-Analysis Software 提取和分析数据。
结果
共有 14 项研究纳入分析。BMD 的平均下降分别为 0.09 [0.05，0.13]、0.14 [0.08，0.20]、0.16 [0.10，0.23]和 0.16 [0.12，0.20] g/cm3，分别在 3、6、12 和 24 个月时，相应的 BMD 丢失率为 9.3%、13.2%、15.8%和 15.4%。研究之间存在高度异质性（大多数时间点 I>90%）。
结论
总之，TKA 后前 6 个月 BMD 迅速且显著下降 15%，持续到 24 个月。更好地了解围手术期骨健康优化如何影响 BMD 丢失和假体周围骨折的发生率至关重要。
证据水平
治疗学 II 级。
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