Zhang Yi, Pei Hang, Wang Chao, Wang Guanyin, Shen Zan, Hua Jiang, He Bangjian
The First School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China.
Department of Orthopedics, Anji County Hospital of Chinese Medicine, Zhejiang, China.
Haemophilia. 2025 Mar;31(2):275-285. doi: 10.1111/hae.15150. Epub 2025 Jan 27.
Arthroplasty is the standard treatment for end-stage haemophilic knee arthritis; however, the choice between single knee arthroplasty (SKA) and bilateral knee arthroplasty (BKA) in a single operation remains controversial due to the risks specific to haemophiliacs.
Two independent researchers conducted searches across CNKI, CBM, Wanfang, PubMed, Cochrane Library, Embase, and Web of Science, with the last search performed on 15 October 2024. Study results include joint function, complication and various cost. Literature quality was assessed using the Newcastle-Ottawa Scale (NOS). Outcomes were evaluated with fixed-effects or random-effects models, while heterogeneity and publication bias were also assessed.
Nine studies involving 309 haemophilia patients were included, with 166 in SKA group and 143 in BKA group. No statistically significant differences were observed between the SKA and BKA groups in range of motion (95% CI: -0.22 [-3.57, 3.13], p = 0.90), Hospital for Special Surgery score (95% CI: -2.13 [-4.89, 0.64], p = 0.13), flexion degree (95% CI: -2.38 [-7.22, 2.46], p = 0.33), cost (95% CI: -0.24 [-0.94, 0.45], p = 0.49), complication rate (95% CI: 1.31 [-0.79, 2.17], p = 0.29), hospital stay (95% CI: 0.25 [-2.06, 2.57], p = 0.83), and coagulation factor usage (p = 0.49). However, The SKA group outperformed the BKA group in terms of operative time, postoperative drainage, and transfusion volume (p < 0.001).
Our study indicates that, apart from differences in operative time, transfusion volume, and blood loss, SKA and BKA show no significant differences in postoperative joint function, complication rates, or costs.
关节置换术是终末期血友病性膝关节炎的标准治疗方法；然而，由于血友病患者的特殊风险，单膝关节置换术（SKA）和双侧膝关节置换术（BKA）在单次手术中的选择仍存在争议。
两名独立研究人员在知网、中国生物医学文献数据库、万方、PubMed、考克兰图书馆、Embase和科学网进行检索，最后一次检索于2024年10月15日进行。研究结果包括关节功能、并发症和各种费用。使用纽卡斯尔-渥太华量表（NOS）评估文献质量。采用固定效应或随机效应模型评估结果，同时评估异质性和发表偏倚。
纳入9项研究，共309例血友病患者，其中SKA组166例，BKA组143例。SKA组和BKA组在活动范围（95%CI：-0.22[-3.57,3.13]，p=0.90）、特种外科医院评分（95%CI：-2.13[-4.89,0.64]，p=0.13）、屈曲度（95%CI：-2.38[-7.22,2.46]，p=0.33）、费用（95%CI：-0.24[-0.94,0.45]，p=0.49）、并发症发生率（95%CI：1.31[-0.79,2.17]，p=0.29）、住院时间（95%CI：0.25[-2.06,2.57]，p=0.83）和凝血因子使用量（p=0.49）方面均未观察到统计学显著差异。然而，SKA组在手术时间、术后引流量和输血量方面优于BKA组（p<0.001）。
我们的研究表明，除手术时间、输血量和失血量存在差异外，SKA和BKA在术后关节功能、并发症发生率或费用方面无显著差异。
