Lee Seung Hoon, Kim Joong Il, Choi Wonchul, Kim Tae Woo, Lee Yong Seuk
Department of Orthopaedic Surgery, Veterans Health Service Medical Center, Seoul, South Korea.
Department of Orthopaedic Surgery, Hallym University Kangnam Sacred Heart Hospital, Seoul, South Korea.
Knee Surg Relat Res. 2020 Aug 28;32(1):44. doi: 10.1186/s43019-020-00064-1.
INTRODUCTION/PURPOSE: The purpose of this systematic review was to evaluate the effect of iron supplementation during total knee arthroplasty (TKA): (1) Is the iron supplementation necessary during TKA? (2) When is the optimal timing of iron supplementation? (3) Which is better, between orally and intravenously administered iron supplementation? And (4) What is the optimal dose of iron supplementation?
A rigorous and systematic approach was used and each of the selected studies was evaluated for methodological quality. Data about study design, total number of cases enrolled, iron administration method, timing, and dose were extracted. Change in hemoglobin and transfusion rates were extracted to evaluate the effectiveness of iron supplementation.
Eleven studies were included in the final analysis. Most of studies reported that hemoglobin change between iron and control group did not show any difference. Only one study reported that iron supplementation could reduce the decrease in hemoglobin. However, transfusion rate showed a decrease in the iron supplementation group compared with the control group. There was no clear consensus on the optimum timing and dose of iron supplementation and intravenously administered iron was more effective than orally administered iron, especially in anemic patients.
Iron supplementation is not clear as a way to raise hemoglobin levels after TKA, but an effective treatment for lowering transfusion rate, especially in patients with anemia. We could not determine the optimal timing and dose of the iron. Intravenously administered iron was similar to, or better than, orally administered iron for improving hemoglobin levels and transfusion rate.
引言/目的：本系统评价的目的是评估全膝关节置换术（TKA）期间补铁的效果：（1）TKA期间是否需要补铁？（2）补铁的最佳时机是什么？（3）口服补铁和静脉补铁哪种更好？以及（4）补铁的最佳剂量是多少？
采用严谨且系统的方法，对每项入选研究的方法学质量进行评估。提取有关研究设计、纳入病例总数、铁剂给药方法、时间和剂量的数据。提取血红蛋白变化和输血率以评估补铁的有效性。
最终分析纳入了11项研究。大多数研究报告称，补铁组和对照组之间的血红蛋白变化没有差异。只有一项研究报告称，补铁可减少血红蛋白的下降。然而，与对照组相比，补铁组的输血率有所下降。关于补铁的最佳时机和剂量尚无明确共识，静脉补铁比口服补铁更有效，尤其是在贫血患者中。
TKA后补铁作为提高血红蛋白水平的方法尚不清楚，但它是降低输血率的有效治疗方法，尤其是在贫血患者中。我们无法确定补铁的最佳时机和剂量。静脉补铁在改善血红蛋白水平和输血率方面与口服补铁相似或更好。
