全膝关节置换术后重返运动和重返工作岗位：系统评价和荟萃分析。
Return to Sports and Return to Work After Total Knee Arthroplasty: A Systematic Review and Meta-Analysis.
机构信息
Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio.
Case Western Reserve University School of Medicine, Cleveland, Ohio.
出版信息
JBJS Rev. 2023 Jul 27;11(7). doi: e22.00250. eCollection 2023 Jul 1.
BACKGROUND
Return to work (RTW) and sports (RTS) are critical gauges to improvement among patients after total knee arthroplasty (TKA). This study aimed to determine rates, timelines, and prognostic factors associated with RTW and RTS outcomes after primary TKA.
METHODS
A systematic review was conducted on MEDLINE, Embase, and CENTRAL databases, with 44 studies meeting inclusion/exclusion criteria. The risk of bias was assessed using the Risk of Bias in Nonrandomized Studies of Interventions tool. Meta-analysis and pooled analysis were conducted when possible with forest plots to summarize odds ratios and associated 95% confidence intervals (CIs).
RESULTS
The pooled RTW rate across all studies was 65% (95% CI, 51%-77%), with rates varying significantly from 10% to 98%. The mean time to RTW was of 12.9 weeks (range, 5-42). A time point analysis showed increasing RTW rates with a maximum rate at 1 year of 90%. Increased age was associated with lower RTW rates (p < 0.001). The RTS rate ranged from 36% to 100%, with a pooled rate of 82% (95% CI, 72%-89%). The mean time to RTS was 20.1 weeks (range, 16-24). A wide range of reported recurrence rates was observed among different sports (subgroup differences, p ≤ 0.001). The RTS ranged from 43% to 98%, with a pooled proportion of 76% (95% CI, 59%-87%, I2 = 91%) for low-intensity sports, and from 0% to 55% for high-intensity sports, with a pooled proportion of 35% (95% CI, 20-52, I2 = 70%).
CONCLUSION
Most patients successfully return to sports and work after TKA, with rates of RTW increasing to 90% after 1 year. Such outcomes are heavily influenced by nonmodifiable (e.g., age) and modifiable (e.g., intensity of sports/employment) factors. Generally, young adults and patients with low-demand jobs can be reinitiated earlier, albeit with increasing restrictions with rising intensity. Providers should screen patients for desire to RTW and/or RTS after surgery and provide appropriate recommendations as part of necessary preoperative education and postoperative care.
LEVEL OF EVIDENCE
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
背景
全膝关节置换术（TKA）后，患者的工作（RTW）和运动（RTS）恢复是改善的关键指标。本研究旨在确定与初次 TKA 后 RTW 和 RTS 结果相关的发生率、时间和预后因素。
方法
对 MEDLINE、Embase 和 CENTRAL 数据库进行系统综述，符合纳入/排除标准的 44 项研究。使用非随机干预研究风险评估工具评估偏倚风险。当可能时，使用森林图进行荟萃分析和汇总分析，以总结优势比和相关的 95%置信区间（CI）。
结果
所有研究的总体 RTW 率为 65%（95%CI，51%-77%），而发生率差异显著，范围为 10%-98%。RTW 的平均时间为 12.9 周（范围，5-42）。时间点分析表明，随着 1 年时 RTW 率最高达 90%，RTW 率逐渐增加。年龄增加与 RTW 率降低相关（p < 0.001）。RTS 率为 36%-100%，总体 RTS 率为 82%（95%CI，72%-89%）。RTS 的平均时间为 20.1 周（范围，16-24）。不同运动的报道复发率差异很大（亚组差异，p ≤ 0.001）。RTS 率为 43%-98%，低强度运动的总体比例为 76%（95%CI，59%-87%，I2 = 91%），高强度运动的总体比例为 35%（95%CI，20%-52%，I2 = 70%）。
结论
大多数患者在 TKA 后成功重返工作和运动，1 年后 RTW 率增加到 90%。这些结果受到不可改变（例如，年龄）和可改变（例如，运动/就业强度）因素的强烈影响。一般来说，年轻成人和低需求工作的患者可以更早开始重新开始，尽管随着强度的增加，限制也会增加。提供者应在手术后筛查患者对 RTW 和/或 RTS 的愿望，并作为必要的术前教育和术后护理的一部分提供适当的建议。
证据水平
治疗性三级。有关证据水平的完整描述，请参阅作者说明。
Zotero 插件