Patel Akshar V, Duey Akiro H, Stevens Andrew J, Vaghani Parth A, Cvetanovich Gregory L, Bishop Julie Y, Rauck Ryan C
Department of Orthopaedics, The Ohio State Wexner Medical Center, 2835 Fred Taylor.Dr, Columbus, OH, USA.
Department of Orthopaedics, Icahn School of Medicine-Mount Sinai Hospital, New York City, NY, USA.
J Orthop. 2022 Nov 26;35:150-154. doi: 10.1016/j.jor.2022.11.015. eCollection 2023 Jan.
The purpose of this study is to report a systematic review and meta-analysis of solid organ transplant (SOT) patients undergoing shoulder arthroplasty to compare functional and radiographic outcomes, demographics, and complications with non-transplant patients.
Studies were included if they examined patients undergoing shoulder arthroplasty in the setting of prior solid organ transplantation and included post operative range of motion, patient-reported outcomes, complications, or revisions. Studies were excluded if they were national database analyses or lacked clinical data. Pubmed, MEDLine, Scopus, and Web of Science were queried using relevant search terms in July 2022. Data was pooled, weighted, and a paired -test and chi-square analysis was performed.
There were 71 SOT and 159 non-SOT shoulders included in the study. The most common indication for surgery was avascular necrosis (n = 26) in the solid organ transplant group and osteoarthritis (n = 60) in the non-SOT group. Forward elevation, external rotation, ASES, and VAS pain scores improved significantly in both cohorts following surgery. There was no significant difference in age at surgery (p-value = 0.20), postoperative forward elevation (p-value = 0.08), postoperative external rotation (0.84), and postoperative ASES scores (p-value = 0.11) between the two cohorts. VAS pain scores were significantly lower in the SOT cohort (p-value<0.01). The risk of death was significantly higher in the SOT group (p-value<0.01). but the rate of overall complications (p = 0.47), surgical complication (p-value = 0.79), or revision surgery (p-value = 1.00) was not significantly different between the two cohorts.
Shoulder arthroplasty is a safe, effective option in patients following solid organ transplant. There is not an increased risk of adverse outcomes, and SOT patients had comparable range of motion and patient-reported outcomes when compared to their non-SOT peers.
III.
本研究的目的是对接受肩关节置换术的实体器官移植（SOT）患者进行系统评价和荟萃分析，以比较其与非移植患者的功能和影像学结果、人口统计学特征及并发症。
纳入的研究需检查曾接受实体器官移植并接受肩关节置换术的患者，且包括术后活动范围、患者报告的结果、并发症或翻修情况。若研究为国家数据库分析或缺乏临床数据，则予以排除。于2022年7月使用相关检索词查询了PubMed、MEDLine、Scopus和Web of Science。对数据进行汇总、加权，并进行配对t检验和卡方分析。
本研究纳入了71例SOT患者的肩关节和159例非SOT患者的肩关节。实体器官移植组最常见的手术指征是缺血性坏死（n = 26），非SOT组是骨关节炎（n = 60）。两组患者术后前屈、外旋、ASES和VAS疼痛评分均显著改善。两组患者的手术年龄（p值 = 0.20）、术后前屈（p值 = 0.08）、术后外旋（0.84）和术后ASES评分（p值 = 0.11）无显著差异。SOT组的VAS疼痛评分显著更低（p值<0.01）。SOT组的死亡风险显著更高（p值<0.01），但两组的总体并发症发生率（p = 0.47）、手术并发症发生率（p值 = 0.79）或翻修手术发生率（p值 = 1.00）无显著差异。
肩关节置换术对于实体器官移植后的患者是一种安全、有效的选择。不良后果风险未增加，与非SOT患者相比，SOT患者的活动范围和患者报告的结果具有可比性。
III级
