Department of Orthopaedics, National Cheng Kung University Hospital, Tainan, Taiwan.
Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital.
Bone Joint J. 2019 Dec;101-B(12):1489-1497. doi: 10.1302/0301-620X.101B12.BJJ-2019-0799.R1.
The aim of this meta-analysis was to compare the outcome of total elbow arthroplasty (TEA) undertaken for rheumatoid arthritis (RA) with TEA performed for post-traumatic conditions with regard to implant failure, functional outcome, and perioperative complications.
We completed a comprehensive literature search on PubMed, Web of Science, Embase, and the Cochrane Library and conducted a systematic review and meta-analysis. Nine cohort studies investigated the outcome of TEA between RA and post-traumatic conditions. The preferred reporting items for systematic reviews and meta-analysis (Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)) guidelines and Newcastle-Ottawa scale were applied to assess the quality of the included studies. We assessed three major outcome domains: implant failures (including aseptic loosening, septic loosening, bushing wear, axle failure, component disassembly, or component fracture); functional outcomes (including arc of range of movement, Mayo Elbow Performance Score (MEPS), and the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire), and perioperative complications (including deep infection, intraoperative fracture, postoperative fracture, and ulnar neuropathy).
This study included a total of 679 TEAs for RA (n = 482) or post-traumatic conditions (n = 197). After exclusion, all of the TEAs included in this meta-analysis were cemented with linked components. Our analysis demonstrated that the RA group was associated with a higher risk of septic loosening after TEA (odds ratio (OR) 3.96, 95% confidence interval (CI) 1.11 to 14.12), while there was an increased risk of bushing wear, axle failure, component disassembly, or component fracture in the post-traumatic group (OR 4.72, 95% CI 2.37 to 9.35). A higher MEPS (standardized mean difference 0.634, 95% CI 0.379 to 0.890) was found in the RA group. There were no significant differences in arc of range of movement, DASH questionnaire, and risk of aseptic loosening, deep infection, perioperative fracture, or ulnar neuropathy.
The aetiology of TEA surgery appears to have an impact on the outcome in terms of specific modes of implant failures. RA patients might have a better functional outcome after TEA surgery. Cite this article: 2019;101-B:1489-1497.
本次荟萃分析旨在比较类风湿关节炎（RA）患者与创伤后患者行全肘关节置换术（TEA）的疗效，包括假体失败、功能结果和围手术期并发症。
我们在 PubMed、Web of Science、Embase 和 Cochrane Library 上进行了全面的文献检索，并进行了系统评价和荟萃分析。9 项队列研究调查了 RA 和创伤后条件下 TEA 的结果。本研究采用系统评价和荟萃分析的首选报告项目（系统评价和荟萃分析的首选报告项目（PRISMA））指南和纽卡斯尔-渥太华量表来评估纳入研究的质量。我们评估了三个主要的结果领域：假体失败（包括无菌性松动、感染性松动、衬套磨损、轴失效、组件拆卸或组件断裂）；功能结果（包括活动范围弧、 Mayo 肘关节功能评分（MEPS）和上肢残疾问卷（DASH））；和围手术期并发症（包括深部感染、术中骨折、术后骨折和尺神经病变）。
这项研究共纳入了 679 例用于 RA（n=482）或创伤后条件（n=197）的 TEA。排除后，本荟萃分析纳入的所有 TEA 均采用连接组件进行了骨水泥固定。我们的分析表明，RA 组在 TEA 后发生感染性松动的风险更高（比值比（OR）3.96，95%置信区间（CI）1.11 至 14.12），而创伤后组发生衬套磨损、轴失效、组件拆卸或组件断裂的风险更高（OR 4.72，95% CI 2.37 至 9.35）。RA 组的 MEPS 更高（标准化均数差 0.634，95% CI 0.379 至 0.890）。活动范围弧、DASH 问卷和无菌性松动、深部感染、围手术期骨折或尺神经病变的风险无显著差异。
TEA 手术的病因似乎会影响假体失效的具体模式的结果。RA 患者 TEA 术后功能结果可能更好。
