Hald Julius T, Knudsen Ulrik K, Petersen Michael M, Lindberg-Larsen Martin, El-Galaly Anders B, Odgaard Anders
Department of Orthopedic Surgery, Rigshospitalet, Copenhagen University, Copenhagen, Denmark.
Department of Orthopedic Surgery, University of Copenhagen, Gentofte Hospital, Copenhagen, Denmark.
Bone Jt Open. 2024 Aug 7;5(8):644-651. doi: 10.1302/2633-1462.58.BJO-2024-0073.R1.
The aim of this study was to perform a systematic review and bias evaluation of the current literature to create an overview of risk factors for re-revision following revision total knee arthroplasty (rTKA).
A systematic search of MEDLINE and Embase was completed in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. The studies were required to include a population of index rTKAs. Primary or secondary outcomes had to be re-revision. The association between preoperative factors and the effect on the risk for re-revision was also required to be reported by the studies.
The search yielded 4,847 studies, of which 15 were included. A majority of the studies were retrospective cohorts or registry studies. In total, 26 significant risk factors for re-revision were identified. Of these, the following risk factors were consistent across multiple studies: age at the time of index revision, male sex, index revision being partial revision, and index revision due to infection. Modifiable risk factors were opioid use, BMI > 40 kg/m, and anaemia. History of one-stage revision due to infection was associated with the highest risk of re-revision.
Overall, 26 risk factors have been associated with an increased risk of re-revision following rTKA. However, various levels of methodological bias were found in the studies. Future studies should ensure valid comparisons by including patients with identical indications and using clear definitions for accurate assessments.
本研究旨在对当前文献进行系统综述和偏倚评估，以概述全膝关节置换翻修术（rTKA）后再次翻修的危险因素。
按照系统评价和Meta分析的首选报告项目（PRISMA）指南，对MEDLINE和Embase进行了系统检索。纳入的研究需包含初次rTKA人群。主要或次要结局必须是再次翻修。研究还需报告术前因素与再次翻修风险影响之间的关联。
检索得到4847项研究，其中15项被纳入。大多数研究为回顾性队列研究或登记研究。共确定了26个再次翻修的显著危险因素。其中，以下危险因素在多项研究中一致：初次翻修时的年龄、男性、初次翻修为部分翻修以及因感染进行初次翻修。可改变的危险因素包括使用阿片类药物、BMI>40kg/m²和贫血。因感染进行一期翻修的病史与再次翻修的最高风险相关。
总体而言，26个危险因素与rTKA后再次翻修风险增加相关。然而，研究中发现了不同程度的方法学偏倚。未来的研究应通过纳入具有相同适应证的患者并使用明确的定义进行准确评估，以确保有效的比较。
