Department of General Surgery, The Second Affiliated Hospital of Jianghan University (The Fifth Hospital of Wuhan), Wuhan, Hubei, 430050, China.
Department of Oncology, The Second Affiliated Hospital of Jianghan University (The Fifth Hospital of Wuhan), Wuhan, Hubei, 430050, China.
Int J Surg. 2022 Aug;104:106778. doi: 10.1016/j.ijsu.2022.106778. Epub 2022 Jul 20.
At present, whether bariatric surgery before total knee arthroplasty (TKA) affects the prognosis of subsequent TKA has been a topic of debate in the academic community. The primary purpose of this systematic review and meta-analysis was to investigate the effect of previous bariatric surgery on prosthetic revisions and postoperative complications after TKA.
We included prospective and observational studies published in English involving patients who had undergone bariatric surgery prior to TKA and compared them with morbidly obese patients with no history of bariatric surgery. The Newcastle-Ottawa Scale was used to assess the methodological quality of non-randomized case-control studies. The outcomes included revisions, infections, venous thromboembolism (VTE), blood transfusion, mortality, stiffness or manipulation under anesthesia (MUA), and medical complications.
Of the 9 included studies with 166047 patients, 4 were matched cohort studies, 2 were unmatched cohort, and 3 were database studies. Methodological quality was high in ten studies and moderate in thirteen studies. Our analysis demonstrated that patients with TKA who had undergone prior bariatric surgery were associated with increased risks of long-term revision, long-term infection, long-term stiffness or MUA and blood transfusions, whereas prior bariatric surgery did not increase the risk of short-term complications and short-term revision.
This meta-analysis highlights the risks of bariatric surgery prior to TKA and suggests that prior bariatric surgery may increase the risk of perioperative blood transfusion and also the risk of revision and infection in long-term follow-up. Surgeons can use this information to help counsel patients undergoing bariatric surgery before primary TKA.
目前，减重手术是否会影响全膝关节置换术（TKA）的预后，这一直是学术界争论的话题。本系统评价和荟萃分析的主要目的是探讨既往减重手术对 TKA 后假体翻修和术后并发症的影响。
我们纳入了发表在英文期刊上的前瞻性和观察性研究，这些研究涉及接受过减重手术的 TKA 患者，并将其与无减重手术史的病态肥胖患者进行比较。使用纽卡斯尔-渥太华量表（Newcastle-Ottawa Scale）评估非随机病例对照研究的方法学质量。结果包括翻修、感染、静脉血栓栓塞症（VTE）、输血、死亡率、僵硬或麻醉下手法复位（MUA）以及医疗并发症。
在纳入的 9 项研究中，共涉及 166047 例患者，其中 4 项为匹配队列研究，2 项为非匹配队列研究，3 项为数据库研究。10 项研究的方法学质量较高，13 项研究的方法学质量为中等。我们的分析表明，既往接受过减重手术的 TKA 患者发生长期翻修、长期感染、长期僵硬或 MUA 和输血的风险增加，而短期并发症和短期翻修的风险并未增加。
本荟萃分析强调了 TKA 前减重手术的风险，并表明既往减重手术可能增加围手术期输血的风险，并且在长期随访中也增加了翻修和感染的风险。外科医生可以利用这些信息来帮助接受 TKA 前减重手术的患者进行咨询。
