Challoumas Dimitris, Munn David, Stockdale Henrietta, Ng Nigel, McCormick Michael, Altell Tareq, Joiya Shaheer, Horton James, Jones Bryn
Department of Trauma and Orthopaedic Surgery, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 0SF, Scotland, UK.
Arthroplasty. 2023 Jul 6;5(1):34. doi: 10.1186/s42836-023-00190-7.
This study aimed to present and critically appraise the best available evidence investigating associations between some pre-defined patient-related characteristics and perioperative complications or other outcomes in THA and TKA.
Electronic databases were searched (Medline, EMBASE, Scopus, CENTRAL) for systematic reviews assessing the following pre-defined patient-related characteristics as possible risk factors for worse peri-operative outcomes in THA and TKA: smoking, alcohol excess, rheumatoid arthritis, human immunodeficiency virus infection, hepatitis C virus infection, mental health conditions, and solid organ transplantation. Our primary outcome was periprosthetic joint infection. Results were analysed separately for THA, TKA and THA/TKA (mixed data).
Based on at least two systematic reviews being in agreement, the following patient-related characteristics were associated with increased incidence of complications as follows: a) Smoking for all-cause revision in THA, for periprosthetic joint infection in TKA and THA/TKA; b) alcohol excess for periprosthetic joint infection in THA/TKA; c) human immunodeficiency virus for periprosthetic joint infection in THA/TKA; d) hepatitis C virus for overall complications, periprosthetic joint infection and all-cause revision in THA and THA/TKA, and for overall complications in TKA. Our study found conflicting evidence for a) smoking as a risk factor for periprosthetic joint infection and aseptic loosening in THA; b) human immunodeficiency virus as a risk factor for all-cause revision for THA/TKA; c) hepatitis C virus as a risk factor for periprosthetic joint infection and all-cause revision in TKA. No certainty of evidence was assigned to these results as this was not assessed by the authors of the majority of the included systematic reviews.
We found that smoking, excess alcohol consumption, RA, and infection with HIV and HCV were associated with a higher incidence of periprosthetic joint infection in one or both of THA and TKA or mixed THA/TKA data. All our results should be interpreted and communicated to patients with caution as the quality of the included systematic reviews was generally poor.
本研究旨在展示并严格评估关于某些预先定义的患者相关特征与全髋关节置换术（THA）和全膝关节置换术（TKA）围手术期并发症或其他结局之间关联的现有最佳证据。
检索电子数据库（Medline、EMBASE、Scopus、CENTRAL）以获取系统评价，评估以下预先定义的患者相关特征作为THA和TKA中围手术期结局较差的可能危险因素：吸烟、过量饮酒、类风湿性关节炎、人类免疫缺陷病毒感染、丙型肝炎病毒感染、心理健康状况和实体器官移植。我们的主要结局是假体周围关节感染。分别对THA、TKA和THA/TKA（混合数据）的结果进行分析。
基于至少两项系统评价达成一致，以下患者相关特征与并发症发生率增加相关：a）吸烟与THA的全因翻修、TKA和THA/TKA的假体周围关节感染相关；b）过量饮酒与THA/TKA的假体周围关节感染相关；c）人类免疫缺陷病毒与THA/TKA的假体周围关节感染相关；d）丙型肝炎病毒与THA和THA/TKA的总体并发症、假体周围关节感染和全因翻修相关，以及与TKA的总体并发症相关。我们的研究发现以下方面存在相互矛盾的证据：a）吸烟作为THA中假体周围关节感染和无菌性松动的危险因素；b）人类免疫缺陷病毒作为THA/TKA全因翻修的危险因素；c）丙型肝炎病毒作为TKA中假体周围关节感染和全因翻修的危险因素。由于大多数纳入的系统评价的作者未对此进行评估，因此这些结果未被赋予证据确定性。
我们发现吸烟、过量饮酒、类风湿性关节炎以及感染人类免疫缺陷病毒和丙型肝炎病毒与THA和TKA其中之一或两者或THA/TKA混合数据中较高的假体周围关节感染发生率相关。由于纳入的系统评价质量普遍较差，所有结果在解释并告知患者时都应谨慎。
