Zaronias Kailey J, Arnold Keith E, Hecht Christian J, Porto Joshua R, Pumo Thomas J, Kamath Atul F
Case Western Reserve University School of Medicine, Cleveland, OH, 44106, USA.
Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, 44195, USA.
J Orthop. 2025 May 12;69:176-185. doi: 10.1016/j.jor.2025.04.015. eCollection 2025 Nov.
BACKGROUND: For patients undergoing total joint arthroplasty (TJA), sarcopenia has been described as a modifiable risk factor for several medical complications and adverse functional and patient-reported outcomes. However, findings have varied among orthopaedic literature as some studies encompass patients who do not have a clinical diagnosis of sarcopenia. This systematic review therefore sought to clarify the association between clinically diagnosed sarcopenia and post-TJA (1) functional outcomes, (2) patient-reported outcome measures (PROMs), and (3) complications. METHODS: This review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The PubMed, Google Scholar, and EBSCOhost databases were queried for articles evaluating the effect of preoperative sarcopenia or sarcopenic obesity on total hip or total knee arthroplasty (THA; TKA) outcomes. Exclusion criteria included case reports, non-English publications, systematic reviews, and duplicate studies among databases. Eligibility screening of articles and data extraction were performed independently by two reviewers. Risk of bias was assessed using the Methodological index for Nonrandomized Studies tool. RESULTS: The synthesis of evidence indicates that preoperative sarcopenia does not substantially impact functional outcomes such as gait speed, one-legged stand time, or postoperative knee range of motion after THA or TKA. However, sarcopenic patients tend to report worse PROMs post-TJA than non-sarcopenic patients, particularly in the short term. Complications are more frequent in sarcopenic patients post-TKA, including higher rates of pneumonia, urinary retention, anemia, and deep vein thrombosis. Orthopaedic-related complications, such as prosthetic dislocation and fragility fractures, are also more common after both THA and TKA. Surgical costs are higher for both sarcopenic patients undergoing either THA or TKA, with increased day-of-surgery and 90-day care costs. CONCLUSION: Sarcopenic patients are at an increased risk for complications and impaired performance and outcome measures following TJA. Surgeons may consider preoperative optimization and rehabilitation in TJA patients with sarcopenia.
背景：对于接受全关节置换术（TJA）的患者，肌肉减少症已被描述为多种医学并发症以及不良功能和患者报告结局的一个可改变的风险因素。然而，骨科文献中的研究结果各不相同，因为一些研究纳入了未临床诊断为肌肉减少症的患者。因此，本系统评价旨在阐明临床诊断的肌肉减少症与全关节置换术后（1）功能结局、（2）患者报告结局指标（PROMs）和（3）并发症之间的关联。 方法：本评价按照系统评价和Meta分析的首选报告项目（PRISMA）指南进行。在PubMed、谷歌学术和EBSCOhost数据库中检索评估术前肌肉减少症或肌肉减少性肥胖对全髋关节或全膝关节置换术（THA；TKA）结局影响的文章。排除标准包括病例报告、非英文出版物、系统评价以及数据库中的重复研究。文章的合格性筛选和数据提取由两名审阅者独立进行。使用非随机研究的方法学指标工具评估偏倚风险。 结果：证据综合表明，术前肌肉减少症对THA或TKA后的功能结局，如步态速度、单腿站立时间或术后膝关节活动范围，没有实质性影响。然而，肌肉减少症患者在全关节置换术后报告的PROMs往往比非肌肉减少症患者更差，尤其是在短期内。全膝关节置换术后肌肉减少症患者的并发症更频繁，包括肺炎、尿潴留、贫血和深静脉血栓形成的发生率更高。骨科相关并发症，如假体脱位和脆性骨折，在THA和TKA后也更常见。接受THA或TKA的肌肉减少症患者的手术成本更高，手术当天和90天护理成本增加。 结论：肌肉减少症患者在全关节置换术后发生并发症以及功能和结局指标受损的风险增加。外科医生可考虑对患有肌肉减少症 的全关节置换术患者进行术前优化和康复治疗。
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