一项系统评价和荟萃分析比较了类风湿性关节炎与骨关节炎患者行全膝关节置换术后的结局。

PURPOSE: Total knee arthroplasty (TKA) in patients with osteoarthritis (OA) are considered to be a successful procedure, but with little being known about outcomes in patients with rheumatoid arthritis (RA). The aim of this study was to compare the outcomes of TKA in patients with RA versus OA. METHODS: Data were obtained from PubMed, Cochrane Library, EBSCO and Scopus for all available studies comparing the outcomes of THA in RA and OA patients (From January 1, 2000 to October 15, 2022). Outcomes of interest included infection, revision, venous thromboembolism (VTE), mortality, periprosthetic fractures, prosthetic loosening, length of stay, and satisfaction. Two reviewers independently assessed each study for quality and extracted data. The quality of the studies was scored using the Newcastle-Ottawa scale (NOS). RESULTS: Twenty-four articles with a total 8,033,554 patients were included in this review. The results found strong evidence for increased risk of overall infection (OR = 1.61, 95% CI, 1.24-2.07; P = 0.0003), deep infection (OR = 2.06, 95% CI, 1.37-3.09; P = 0.0005), VTE (OR = 0.76, 95% CI, 0.61-0.93; P = 0.008), pulmonary embolism (PE) (OR = 0.84, 95% CI, 0.78-0.90; P<0.00001), periprosthetic fractures (OR = 1.87, 95% CI, 1.60-2.17; P<0.00001); and reasonable evidence for increased risk of deep venous thrombosis (DVT) (OR = 0.74, 95% CI, 0.54-0.99; P = 0.05), and length of stay (OR = 0.07, 95% CI, 0.01-0.14; P = 0.03) after TKA in patients with RA versus OA. There were no significant differences in superficial site infection (OR = 0.84,95% CI, 0.47-1.52; P = 0.57), revision (OR = 1.33,95% CI, 0.79-2.23; P = 0.28), mortality (OR = 1.16,95% CI, 0.87-1.55; P = 0.32), and prosthetic loosening (OR = 1.75, 95% CI, 0.56-5.48; P = 0.34) between the groups. CONCLUSION: Our study demonstrated that patients with RA have a higher risk of postoperative infection, VTE, periprosthetic fracture, and lengths of stay, but did not increase revision rate, prosthetic loosening and mortality compared to patients with OA following TKA. In conclusion, despite RA increased incidence of postoperative complications, TKA should continue to be presented as an effective surgical procedure for patients whose conditions are intractable to conservative and medical management of RA.

目的：全膝关节置换术（TKA）在骨关节炎（OA）患者中被认为是一种成功的手术，但对于类风湿关节炎（RA）患者的结果知之甚少。本研究旨在比较 RA 和 OA 患者 TKA 的结果。

方法：从 PubMed、Cochrane 图书馆、EBSCO 和 Scopus 检索了 2000 年 1 月 1 日至 2022 年 10 月 15 日所有比较 RA 和 OA 患者 THA 结果的可用研究。感兴趣的结果包括感染、翻修、静脉血栓栓塞（VTE）、死亡率、假体周围骨折、假体松动、住院时间和满意度。两名审查员独立评估了每一项研究的质量并提取了数据。使用纽卡斯尔-渥太华量表（NOS）对研究的质量进行评分。

结果：共纳入 24 篇文章，总计 8033554 例患者。结果发现，RA 患者总体感染（OR=1.61，95%CI，1.24-2.07；P=0.0003）、深部感染（OR=2.06，95%CI，1.37-3.09；P=0.0005）、VTE（OR=0.76，95%CI，0.61-0.93；P=0.008）、肺栓塞（PE）（OR=0.84，95%CI，0.78-0.90；P<0.00001）和假体周围骨折（OR=1.87，95%CI，1.60-2.17；P<0.00001）的风险显著增加；深部静脉血栓形成（DVT）（OR=0.74，95%CI，0.54-0.99；P=0.05）和住院时间（OR=0.07，95%CI，0.01-0.14；P=0.03）的风险也有增加。RA 患者的浅表部位感染（OR=0.84，95%CI，0.47-1.52；P=0.57）、翻修（OR=1.33，95%CI，0.79-2.23；P=0.28）、死亡率（OR=1.16，95%CI，0.87-1.55；P=0.32）和假体松动（OR=1.75，95%CI，0.56-5.48；P=0.34）与 OA 患者之间无显著差异。

结论：我们的研究表明，RA 患者术后感染、VTE、假体周围骨折和住院时间的风险较高，但与 OA 患者相比，翻修率、假体松动和死亡率没有增加。总之，尽管 RA 术后并发症发生率较高，但对于那些 RA 病情难以通过保守和药物治疗控制的患者，TKA 仍应继续作为一种有效的手术治疗方法。