全关节置换围手术期蛋白质或氨基酸补充：一项系统评价和荟萃分析

Peri-operative protein or amino acid supplementation for total joint arthroplasty: a systematic review and meta-analysis.

作者信息

Khani Yashar, Salmani Ali, Elahi Mohammad, Elahi Vahed Iman, Sadooghi Rad Elias, Bahrami Samani Alireza, Karami Shaghayegh, Nouroozi Mohammad, Mehrvar Amir

机构信息

Student Research Committee, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Student Research Committee, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.

出版信息

J Orthop Surg Res. 2025 May 2;20(1):439. doi: 10.1186/s13018-025-05847-4.

DOI:10.1186/s13018-025-05847-4

PMID:40317042

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12046708/

Abstract

PURPOSE

Osteoarthritis (OA) affects weight-bearing joints, such as hips and knees, and its prevalence is rising due to factors like obesity and aging. Muscle atrophy, exacerbated by aging and surgery, increases the risk of joint instability and falls. Orthopedic surgeons explore dietary interventions to counteract these effects, with protein supplementation (PS) showing promise. This systematic review and meta-analysis assessed the effectiveness of PS in arthroplasty patients, comparing findings with sports medicine and sarcopenia literature.

METHODS

Following PRISMA guidelines, we searched PubMed, Web of Science, Scopus, and Embase (February 2025) for protein and amino acid supplementation studies in total knee or hip arthroplasty (TKA and THA) patients. The quality assessment used the Cochrane risk of bias and the Newcastle-Ottawa Scale. Meta-analysis calculated effect sizes for muscle atrophy and strength outcomes.

RESULTS

Nineteen studies (903 patients) evaluated oral or intravenous protein/amino acid supplementation over a mean follow-up of 55.2 days. Essential amino acids (EAA) significantly reduced muscle atrophy in quadriceps femoris muscle mass (SMD: 0.69; 95% CI: 0.44 to 0.95) and hamstring muscle mass (SMD: 1.04; 95% CI: 0.52 to 1.55). However, effects on intramuscular adipose tissue (IMAT) and muscle thickness (MT) were inconsistent. Muscle strength outcomes varied, with no significant effect on quadriceps muscle strength (QMS) or handgrip strength (HGS). Intravenous amino acid infusion improved muscle protein synthesis and reduced perioperative blood loss.

CONCLUSIONS

Protein and amino acid supplementation can reduce muscle atrophy in hip or knee arthroplasty patients. While effects on muscle strength and function are mixed, intravenous supplementation offers benefits. Further standardized research is needed to confirm these findings.

TRIAL REGISTRATION

PROSPERO registration code (CRD42024555899).

摘要

目的

骨关节炎（OA）会影响负重关节，如髋关节和膝关节，并且由于肥胖和老龄化等因素，其患病率正在上升。肌肉萎缩因衰老和手术而加剧，会增加关节不稳定和跌倒的风险。骨科医生探索饮食干预措施来抵消这些影响，补充蛋白质（PS）显示出了前景。本系统评价和荟萃分析评估了PS在关节置换术患者中的有效性，并将结果与运动医学和肌肉减少症文献进行比较。

方法

按照PRISMA指南，我们在PubMed、Web of Science、Scopus和Embase（截至2025年2月）中搜索了全膝关节或髋关节置换术（TKA和THA）患者补充蛋白质和氨基酸的研究。质量评估使用了Cochrane偏倚风险评估工具和纽卡斯尔-渥太华量表。荟萃分析计算了肌肉萎缩和力量结果的效应量。

结果

19项研究（903例患者）评估了口服或静脉补充蛋白质/氨基酸，平均随访时间为55.2天。必需氨基酸（EAA）显著减少了股四头肌肌肉质量的萎缩（标准化均数差：0.69；95%置信区间：0.44至0.95）以及腘绳肌肌肉质量的萎缩（标准化均数差：1.04；95%置信区间：0.52至1.55）。然而，对肌内脂肪组织（IMAT）和肌肉厚度（MT）的影响并不一致。肌肉力量结果各不相同，对股四头肌力量（QMS）或握力（HGS）没有显著影响。静脉输注氨基酸可改善肌肉蛋白质合成并减少围手术期失血。