Fu Howell, Peacock Christian, Wang Chao, Kader Deiary, Clement Nick, Asopa Vipin, Sochart David
Academic Surgical Unit, South West London Elective Orthopaedic Centre, Epsom General Hospital, Dorking Road, Epsom, KT18 7EG, UK.
Faculty of Health, Science, Social Care and Education, Kingston University, Kingston Hill, Kingston upon Thames, Surrey, KT2 7LB, UK.
Eur J Orthop Surg Traumatol. 2023 Dec;33(8):3235-3254. doi: 10.1007/s00590-023-03586-y. Epub 2023 May 22.
End-stage knee arthropathy is a recognised complication of haemophilia. It is often treated by total knee arthroplasty (TKA), which is more technically challenging in patients with haemophilia (PwH). It remains unclear what factors may predict implant survivorship and deep infection rate. Therefore, we systematically review the evidence regarding TKA survivorship and infection in PwH, compared to the general population, and determine the important factors influencing survivorship, particularly HIV and CD4 + count.
A systematic literature review was conducted using MEDLINE, EMBASE, and PubMed for studies reporting Kaplan-Meier survivorship for TKA in PwH (PROSPERO CRD42021284644). Meta-analysis was performed for survivorship, and the results compared to < 55-year-olds from the National Joint Registry (NJR). Meta-regression was performed to determine the impact of relevant variables on 10-year survivorship, with a sub-analysis focusing on HIV.
Twenty-one studies were reviewed, totalling 1338 TKAs (average age 39 years). Implant survivorship for PwH at 5, 10, and 15 years was 94%, 86%, and 76% respectively. NJR-reported survivorship for males < 55 years was 94%, 90%, and 86%. Survivorship improved over time (1973-2018), and correlated inversely with HIV prevalence. Infection rate was 5%, compared to 0.5-1% in the NJR. Infection was not significantly increased with higher HIV prevalence, and CD4 + count had no effect. Complications were inconsistently reported.
Survivorship was similar at 5 years but declined thereafter, and infection rate was six-fold higher. HIV was related to worse survivorship, but not increased infection. Meta-analysis was limited by inconsistent reporting, and standardised reporting is required in future studies.
终末期膝关节病是血友病公认的并发症。通常采用全膝关节置换术（TKA）进行治疗，而在血友病患者（PwH）中，该手术在技术上更具挑战性。目前尚不清楚哪些因素可能预测植入物的生存率和深部感染率。因此，我们系统地回顾了与普通人群相比，PwH患者TKA生存率和感染情况的相关证据，并确定影响生存率的重要因素，特别是HIV和CD4+细胞计数。
使用MEDLINE、EMBASE和PubMed进行系统的文献综述，以查找报告PwH患者TKA的Kaplan-Meier生存率的研究（PROSPERO注册号：CRD42021284644）。对生存率进行荟萃分析，并将结果与国家关节注册中心（NJR）中年龄小于55岁的人群进行比较。进行荟萃回归以确定相关变量对10年生存率的影响，并对HIV进行亚组分析。
共纳入21项研究，总计1338例TKA手术（平均年龄39岁）。PwH患者在5年、10年和15年时的植入物生存率分别为94%、86%和76%。NJR报告的年龄小于55岁男性的生存率为94%、90%和86%。生存率随时间（1973 - 2018年）有所提高，且与HIV流行率呈负相关。感染率为5%，而NJR中的感染率为0.5 - 1%。HIV流行率较高时，感染率并未显著增加，且CD4+细胞计数无影响。并发症的报告不一致。
5年时生存率相似，但此后有所下降，感染率高出6倍。HIV与较差的生存率相关，但与感染增加无关。荟萃分析受到报告不一致的限制，未来研究需要标准化报告。
