NIHR Academic Clinical Fellow - Trauma and Orthopaedic Surgery, University of Exeter, St Lukes Campus, Magdalen Road, Exeter, Devon, EX1 2LU, UK.
University Hospitals Plymouth NHS Trust, Derriford Hospital, Plymouth, Devon, PL6 8DH, UK.
BMC Musculoskelet Disord. 2024 Mar 27;25(1):239. doi: 10.1186/s12891-024-07342-z.
There are many consequences of lower limb amputation, including altered biomechanics of gait. It has previously been shown that these can lead to increased rates of osteoarthritis (OA). A common and successful treatment for severe OA is joint replacement. However, it is unclear whether amputees undergoing this surgery can expect the same outcomes or complication profile compared with non-amputees. Furthermore, there are key technical challenges associated with hip or knee replacement in lower limb amputees. This scoping review aimed to identify and summarise the existing evidence base.
This was a systematic scoping review performed according to PRISMA guidelines. An electronic database search of MEDLINE (PubMed), Cochrane Library, EMBASE and CINAHL was completed from the date of inception to 1 April 2023. All peer reviewed literature related to hip or knee replacement among lower limb amputees was included.
Of the 931 records identified, 40 studies were included in this study. The available literature consisted primarily of case reports and case series, with generally low level of evidence. In total, there were 265 patients of which 195 received total hip replacement (THR), 51 received total knee replacement (TKR) and 21 received hip hemiarthroplasty. The most common reason for amputation was trauma (34.2%), and the main indication for joint replacement was OA (77.1%), occurring more frequently in the contralateral limb (66.7%). The outcomes reported varied widely between studies, with most suggesting good functional status post-operatively. A variety of technical tips were reported, primarily concerned with intra-operative control of the residual limb.
There is a need for more observational studies to clearly define the association between amputation and subsequent need for joint replacement. Furthermore, comparative studies are needed to identify whether amputees can be expected to achieve similar functional outcomes after surgery, and if they are at higher risk of certain complications.
下肢截肢会带来许多后果，包括步态生物力学的改变。此前已经表明，这些改变会导致骨关节炎（OA）的发生率增加。对于严重的 OA，一种常见且有效的治疗方法是关节置换。然而，尚不清楚接受这种手术的截肢患者是否可以预期与非截肢患者相同的结果或并发症情况。此外，下肢截肢患者进行髋关节或膝关节置换存在一些关键的技术挑战。本研究旨在确定和总结现有的证据基础。
这是一项按照 PRISMA 指南进行的系统综述。从成立日期到 2023 年 4 月 1 日，对 MEDLINE（PubMed）、Cochrane 图书馆、EMBASE 和 CINAHL 进行了电子数据库搜索。所有与下肢截肢患者髋关节或膝关节置换相关的同行评议文献均包括在内。
在 931 条记录中，有 40 项研究纳入本研究。现有文献主要由病例报告和病例系列组成，证据水平普遍较低。共有 265 名患者，其中 195 名接受了全髋关节置换术（THR），51 名接受了全膝关节置换术（TKR），21 名接受了髋关节半髋关节置换术。截肢最常见的原因是创伤（34.2%），关节置换的主要指征是 OA（77.1%），且更常见于对侧肢体（66.7%）。研究报告的结果差异很大，大多数研究表明术后功能状态良好。报告了多种技术技巧，主要涉及残肢的术中控制。
需要更多的观察性研究来明确截肢与随后关节置换需求之间的关联。此外，需要进行比较研究以确定截肢患者是否可以预期在手术后获得相似的功能结果，以及他们是否存在某些并发症的更高风险。
