PDF(Pubmed)
Abstract：
BACKGROUND: There are many consequences of lower limb amputation, including altered biomechanics of gait. It has previously been shown that these can lead to increased rates of osteoarthritis (OA). A common and successful treatment for severe OA is joint replacement. However, it is unclear whether amputees undergoing this surgery can expect the same outcomes or complication profile compared with non-amputees. Furthermore, there are key technical challenges associated with hip or knee replacement in lower limb amputees. This scoping review aimed to identify and summarise the existing evidence base.
METHODS: This was a systematic scoping review performed according to PRISMA guidelines. An electronic database search of MEDLINE (PubMed), Cochrane Library, EMBASE and CINAHL was completed from the date of inception to 1st April 2023. All peer reviewed literature related to hip or knee replacement among lower limb amputees was included.
RESULTS: Of the 931 records identified, 40 studies were included in this study. The available literature consisted primarily of case reports and case series, with generally low level of evidence. In total, there were 265 patients of which 195 received total hip replacement (THR), 51 received total knee replacement (TKR) and 21 received hip hemiarthroplasty. The most common reason for amputation was trauma (34.2%), and the main indication for joint replacement was OA (77.1%), occurring more frequently in the contralateral limb (66.7%). The outcomes reported varied widely between studies, with most suggesting good functional status post-operatively. A variety of technical tips were reported, primarily concerned with intra-operative control of the residual limb.
CONCLUSIONS: There is a need for more observational studies to clearly define the association between amputation and subsequent need for joint replacement. Furthermore, comparative studies are needed to identify whether amputees can be expected to achieve similar functional outcomes after surgery, and if they are at higher risk of certain complications.
METHODS: This was a systematic scoping review performed according to PRISMA guidelines. An electronic database search of MEDLINE (PubMed), Cochrane Library, EMBASE and CINAHL was completed from the date of inception to 1st April 2023. All peer reviewed literature related to hip or knee replacement among lower limb amputees was included.
RESULTS: Of the 931 records identified, 40 studies were included in this study. The available literature consisted primarily of case reports and case series, with generally low level of evidence. In total, there were 265 patients of which 195 received total hip replacement (THR), 51 received total knee replacement (TKR) and 21 received hip hemiarthroplasty. The most common reason for amputation was trauma (34.2%), and the main indication for joint replacement was OA (77.1%), occurring more frequently in the contralateral limb (66.7%). The outcomes reported varied widely between studies, with most suggesting good functional status post-operatively. A variety of technical tips were reported, primarily concerned with intra-operative control of the residual limb.
CONCLUSIONS: There is a need for more observational studies to clearly define the association between amputation and subsequent need for joint replacement. Furthermore, comparative studies are needed to identify whether amputees can be expected to achieve similar functional outcomes after surgery, and if they are at higher risk of certain complications.
摘要：
背景：下肢截肢有很多后果，包括步态生物力学的改变。先前已显示这些可导致骨关节炎(OA)的发生率增加。严重OA的常见且成功的治疗方法是关节置换。然而,目前尚不清楚接受该手术的截肢者与非截肢者相比是否可以预期相同的结局或并发症.此外，下肢截肢者髋关节或膝关节置换存在关键技术挑战.本范围审查旨在确定和总结现有的证据基础。
方法：这是根据PRISMA指南进行的系统范围审查。MEDLINE（PubMed）的电子数据库搜索，科克伦图书馆,EMBASE和CINAHL从成立之日起至2023年4月1日完成。纳入了所有与下肢截肢者髋关节或膝关节置换相关的同行评审文献。
结果：在确定的931条记录中，这项研究包括40项研究。现有文献主要包括病例报告和病例系列，证据水平普遍较低。总的来说,有265例患者，其中195例接受了全髋关节置换术（THR），51例接受全膝关节置换术（TKR），21例接受髋关节置换术。截肢最常见的原因是外伤(34.2%),关节置换的主要指征为OA（77.1%），更常发生在对侧肢体（66.7％）。报告的结果在研究之间差异很大，大多数建议术后功能状态良好。报告了各种技术提示，主要涉及残肢的术中控制。
结论：需要更多的观察性研究来明确截肢与后续关节置换需求之间的关联。此外，需要进行比较研究，以确定截肢者是否可以预期在手术后获得类似的功能结果，以及他们患某些并发症的风险较高。
方法：这是根据PRISMA指南进行的系统范围审查。MEDLINE（PubMed）的电子数据库搜索，科克伦图书馆,EMBASE和CINAHL从成立之日起至2023年4月1日完成。纳入了所有与下肢截肢者髋关节或膝关节置换相关的同行评审文献。
结果：在确定的931条记录中，这项研究包括40项研究。现有文献主要包括病例报告和病例系列，证据水平普遍较低。总的来说,有265例患者，其中195例接受了全髋关节置换术（THR），51例接受全膝关节置换术（TKR），21例接受髋关节置换术。截肢最常见的原因是外伤(34.2%),关节置换的主要指征为OA（77.1%），更常发生在对侧肢体（66.7％）。报告的结果在研究之间差异很大，大多数建议术后功能状态良好。报告了各种技术提示，主要涉及残肢的术中控制。
结论：需要更多的观察性研究来明确截肢与后续关节置换需求之间的关联。此外，需要进行比较研究，以确定截肢者是否可以预期在手术后获得类似的功能结果，以及他们患某些并发症的风险较高。
