同期双侧全膝关节置换术与住院时间更短但死亡率更高

来源：304关节学术

与分期双侧全膝关节置换术相比，同期双侧全膝

关节置换术与住院时间更短但死亡率更高相关：

一项系统回顾和荟萃分析

译者：沈松坡

背景: 初次全膝关节置换术(TKA)患者满意度较高。然而，关于同时行双侧TKA (simBTKA)和分期行双侧TKA (staBTKA)的安全性和有效性仍存在争议。这项系统回顾和荟萃分析的目的是评估simBTKA和staBTKA的现有证据，并比较临床结果，包括死亡率、并发症和住院时间(LOS)。

方法: 检索2000年1月至2020年3月期间的PubMed、MEDLINE、EMBASE和Cochrane中央数据库。检索词包括“同期”、“分期”和“双侧TKA”。纳入标准包括比较simBTKA和staBTKA结果的研究。对纳入研究的质量进行评估，并对合并数据进行荟萃分析。

结果: 从927个潜在相关标题中，综合定性纳入2001年至2020年间发表的29篇文章，包括257,284例患者。104,207例患者行simBTKA, 153,632例患者行staBTKA。simBTKA与90天的死亡率明显增加(P < .00001, OR 2.24, 95% CI 1.79 - 2.81),增加肺栓塞的发生率(P < .00001, OR 1.69, 95% CI 1.51 - 1.89),静脉血栓形成(P < .00001, OR 1.33, 95% CI 1.23 - 1.43),和神经系统并发症(P =0 .002, OR 1.42, 95% CI 1.13 - -1.77)。staBTKA显著增加浅部和深部感染的发生率(P =0 .02, P < .00001)。两组间一年内的翻修率是近似的。simBTKA的平均LOS时间缩短了2.1天。

结论: SimBTKA可降低感染的发生率和LOS，但可增加90天死亡率、静脉血栓栓塞和神经系统并发症的发生率。翻修率是近似的。应根据每种策略各自的风险对患者进行选择和建议。

Simultaneous Bilateral Total Knee Arthroplasty Is Associated With Shorter Length of Stay but Increased Mortality Compared With Staged Bilateral Total Knee Arthroplasty: A Systematic Review and Meta-Analysis

Background: Primary total knee arthroplasty (TKA) is associated with high patient satisfaction. However, controversy remains regarding the safety and efficacy of conducting simultaneous bilateral (simBTKA) versus staged bilateral TKA (staBTKA). The objective of this systematic review and meta-analysis was to evaluate the current evidence for simBTKA versus staBTKA and compare clinical outcomes including mortality, complications and length of stay (LOS).

Methods: A search was performed of PubMed, MEDLINE, EMBASE and Cochrane central databases be- tween January 2000 and March 2020. Search terms included “simultaneous,” “staged,” and “bilateral TKA.” Inclusion criteria comprised studies comparing outcomes of simBTKA versus staBTKA. Quality of included studies was assessed and meta-analyses of pooled data was conducted.

Results: 29 articles published between 2001 and 2020 were included in qualitative synthesis from 927 potentially relevant titles, comprising 257,284 patients. 104,207 patients underwent simBTKA and 153,632 patients underwent staBTKA. simBTKA was associated with significantly increased 90-day mortality rate (P < .00001, OR 2.24, 95% CI 1.79-2.81), increased incidence of pulmonary embolism (P < .00001, OR 1.69, 95% CI 1.51-1.89), venous thrombosis (P < .00001, OR 1.33, 95% CI 1.23-1.43), and neurological complications (P 1⁄4 .002, OR 1.42, 95% CI 1.13-1.77). Incidence of superficial and deep infection was significantly increased with staBTKA (P 1⁄4 .02, P < .00001 respectively). Revision rate within one year was equivocal. Mean LOS was 2.1 days shorter for simBTKA.

Conclusion: SimBTKA was associated with decreased incidence of infection and LOS but increased incidence of 90-day mortality, venous thromboembolism and neurological complications. Revision rates were equivocal. Patients should be selected and counseled based on the risks respective to each strategy.

文献出处：Makaram NS, Roberts SB, Macpherson GJ. Simultaneous Bilateral Total Knee Arthroplasty Is Associated With Shorter Length of Stay but Increased Mortality Compared With Staged Bilateral Total Knee Arthroplasty: A Systematic Review and Meta-Analysis. J Arthroplasty. 2021 Jan 23:S0883-5403(21)00085-1. doi: 10.1016/j.arth.2021.01.045. Epub ahead of print. PMID: 33589276.