Subramanian Tejas, Uzzo Robert N, Lama John, Mazzucco Michael, Ortiz Simon, Gausden Elizabeth B
Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York; Weill Cornell Medicine, New York, New York.
J Arthroplasty. 2025 Aug;40(8):2186-2195.e1. doi: 10.1016/j.arth.2025.01.018. Epub 2025 Jan 20.
Patients who have Ehlers-Danlos Syndrome (EDS), a group of connective tissue disorders characterized by aberrant collagen synthesis and processing, have an increased likelihood of requiring a total joint arthroplasty (TJA), including total hip arthroplasty or total knee arthroplasty (THA or TKA). This study aimed to synthesize outcomes following TJA in patients who have EDS.
This study was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies that described outcomes of TJA in EDS patients were searched from PubMed, Medline, The Cochrane Library, and Embase. Case series and cohort studies were included if they identified patients who had EDS who underwent either primary THA or TKA. Rates of reoperation and/or revision, instability or frank dislocation, aseptic loosening, periprosthetic fractures, periprosthetic joint infection, medical complications, wound complications, and readmissions were collected and compared to patients who do not have EDS. Individual pooled comparative meta-analysis was performed for each variable. Patient-reported outcome measures were collected and qualitatively described. The search yielded eight publications with 1,769 EDS patients (1,011 THA and 758 TKA) describing outcomes after TJA.
Following THA, EDS patients were at increased risk of all-cause revision (OR [odds ratio] = 2.40, P < 0.001), instability/dislocation (OR = 3.22, P < 0.001), and aseptic loosening (OR = 3.76, P < 0.001). Following TKA, EDS patients were at increased risk of all-cause revision (OR = 1.54, P = 0.006), instability (OR = 2.96, P < 0.001), periprosthetic fracture (OR = 2.91, P = 0.009), and wound complications/hematoma (OR = 2.91, P < 0.001). There were no differences in medical complications, periprosthetic joint infection, or readmission. The Patient-reported outcome measures were similar between the cohorts and significantly improved compared to the baselines.
Patients who have Ehlers-Danlos have an increased risk of implant-related complications following TJA. The EDS patients undergoing arthroplasty may benefit from careful planning with surgical techniques and constrained designs that minimize instability.
患有埃勒斯-当洛综合征（EDS）的患者，这是一组以胶原蛋白合成和加工异常为特征的结缔组织疾病，进行全关节置换术（TJA）的可能性增加，包括全髋关节置换术或全膝关节置换术（THA或TKA）。本研究旨在综合EDS患者TJA后的结果。
本研究按照系统评价和Meta分析的首选报告项目指南进行。从PubMed、Medline、Cochrane图书馆和Embase中检索描述EDS患者TJA结果的研究。如果病例系列和队列研究确定了接受初次THA或TKA的EDS患者，则纳入研究。收集再手术和/或翻修率、不稳定或明显脱位、无菌性松动、假体周围骨折、假体周围关节感染、医疗并发症、伤口并发症和再入院率，并与非EDS患者进行比较。对每个变量进行单独的汇总比较Meta分析。收集患者报告的结局指标并进行定性描述。检索产生了8篇出版物，共1769例EDS患者（1011例THA和758例TKA）描述了TJA后的结果。
THA后，EDS患者全因翻修风险增加（OR[比值比]=2.40，P<0.001）、不稳定/脱位（OR=3.22，P<0.001）和无菌性松动（OR=3.76，P<0.001）。TKA后，EDS患者全因翻修风险增加（OR=1.54，P=0.006）、不稳定（OR=2.96，P<0.001）、假体周围骨折（OR=2.91，P=0.009）和伤口并发症/血肿（OR=2.91，P<于0.001）。医疗并发症、假体周围关节感染或再入院方面无差异。队列之间患者报告的结局指标相似，与基线相比有显著改善。
患有埃勒斯-当洛综合征的患者TJA后植入物相关并发症的风险增加。接受关节置换术的EDS患者可能受益于精心规划手术技术和采用可减少不稳定的受限设计。
