Abstract：
BACKGROUND: Sarcopenia is a progressive loss of skeletal muscle mass and function. It is associated with adverse outcomes after several orthopaedic procedures. However, its role in total joint arthroplasty (TJA) is not fully explored. Therefore, we wanted to conduct a systematic review and meta-analysis to answer the following questions: (1) What is the prevalence of sarcopenia in patients undergoing TJA?; (2) What factors are associated with the prevalence of sarcopenia in patients undergoing TJA?; What is the impact of sarcopenia on medical outcomes following TJA?; and (4) What is the impact of sarcopenia on surgical outcomes following TJA?
METHODS: Electronic databases PubMed, Scopus, Cochrane, and Google Scholar were searched. The data were pooled using the random-effects model and graphically represented by a forest plot. We included a total of 13 studies, evaluating 399,097 patients.
RESULTS: The pooled prevalence of sarcopenia was 20.1% (95% confidence interval [CI] 13.6 to 28.8%; P < .00001; I2 = 94.7%) in total knee arthroplasty (TKA) and 5.2% (95% CI 0.1 to 69.7%; P = .128; I2 = 99.6%) in total hip arthroplasty (THA). Meta-regression found no links between age, sex, body mass index, diabetes, obesity, arthroplasty type, and sarcopenia prevalence in TJA. Sarcopenia increased risk of blood transfusion (odds ratio [OR] 4.68 [95% CI 3.51 to 6.25]; P < .00001), pneumonia (OR 1.94 [95% CI 1.14 to 3.30]; P = .01), urinary tract infection (UTI) (OR 1.64 [95% CI 1.31 to 2.05]; P < .001), prosthetic fracture (OR 2.12 [95% CI 1.51 to 2.98]; P < .0001), prosthetic dislocation (OR 1.99 [95% CI 1.62 to 2.44]; P < .00001), and mechanical loosening (OR 1.78 [95% CI 1.43 to 2.22]; P < .00001) in TKA. Sarcopenic patients were at an increased risk of UTI (OR 1.79 [95% CI 1.32 to 2.43]; P = .0002) and prosthetic loosening (OR 1.97 [95% CI 1.10 to 3.53]; P = .02) post-THA.
CONCLUSIONS: Baseline sarcopenia was prevalent in patients undergoing TJA. It was associated with an increased risk of UTI and prosthetic loosening following TKA and THA. Increased risk of blood transfusion, pneumonia, prosthetic fractures, and mechanical loosening following TKA.
METHODS: Electronic databases PubMed, Scopus, Cochrane, and Google Scholar were searched. The data were pooled using the random-effects model and graphically represented by a forest plot. We included a total of 13 studies, evaluating 399,097 patients.
RESULTS: The pooled prevalence of sarcopenia was 20.1% (95% confidence interval [CI] 13.6 to 28.8%; P < .00001; I2 = 94.7%) in total knee arthroplasty (TKA) and 5.2% (95% CI 0.1 to 69.7%; P = .128; I2 = 99.6%) in total hip arthroplasty (THA). Meta-regression found no links between age, sex, body mass index, diabetes, obesity, arthroplasty type, and sarcopenia prevalence in TJA. Sarcopenia increased risk of blood transfusion (odds ratio [OR] 4.68 [95% CI 3.51 to 6.25]; P < .00001), pneumonia (OR 1.94 [95% CI 1.14 to 3.30]; P = .01), urinary tract infection (UTI) (OR 1.64 [95% CI 1.31 to 2.05]; P < .001), prosthetic fracture (OR 2.12 [95% CI 1.51 to 2.98]; P < .0001), prosthetic dislocation (OR 1.99 [95% CI 1.62 to 2.44]; P < .00001), and mechanical loosening (OR 1.78 [95% CI 1.43 to 2.22]; P < .00001) in TKA. Sarcopenic patients were at an increased risk of UTI (OR 1.79 [95% CI 1.32 to 2.43]; P = .0002) and prosthetic loosening (OR 1.97 [95% CI 1.10 to 3.53]; P = .02) post-THA.
CONCLUSIONS: Baseline sarcopenia was prevalent in patients undergoing TJA. It was associated with an increased risk of UTI and prosthetic loosening following TKA and THA. Increased risk of blood transfusion, pneumonia, prosthetic fractures, and mechanical loosening following TKA.
摘要：
背景：肌肉减少症是骨骼肌质量和功能的进行性丧失。它与几次骨科手术后的不良后果有关。然而,其在全关节置换术（TJA）中的作用尚未完全探讨。因此,我们希望进行系统评价和荟萃分析以回答以下问题：（1）接受TJA的患者中肌肉减少症的患病率是多少？；（2）接受TJA的患者中肌肉减少症的患病率与哪些因素相关？；（4）肌肉减少症对TJA后的医疗结果有何影响？方法；（4）肌肉减少症对TJA后的手术结果有何影响？Scopus,科克伦,和谷歌学者被搜索。使用随机效应模型汇总数据，并用森林地块进行图形表示。我们总共纳入了13项研究，评估399,097名患者。
结果：在全膝关节置换术（TKA）中，肌肉减少症的合并患病率为20.1％（95％CI[置信区间]13.6至28.8％；P<0.00001；I2=94.7％），在全髋关节置换术（THA）中为5.2％（95％CI0.1至69.7％；P=0.128；I2=99.6％）。元回归发现年龄之间没有联系，性别,体重指数（BMI），糖尿病,肥胖，关节成形术类型,TJA中的肌少症患病率。肌肉减少症增加输血风险（OR[比值比]4.68[95%CI3.51至6.25]；P<0.00001），肺炎（OR1.94[95%CI1.14至3.30]；P=0.01），尿路感染UTI(OR1.64[95%CI1.31to2.05];P<0.001),假体骨折（OR2.12[95％CI1.51至2.98]；P<0.0001），假体脱位（OR1.99[95％CI1.62至2.44]；P<0.00001），TKA中机械松动（OR1.78[95%CI1.43至2.22]；P<0.00001）。肌肉减少患者在THA后UTI(OR1.79[95%CI1.32至2.43];P=0.0002)和假体松动(OR1.97[95%CI1.10至3.53];P=0.02)的风险增加。
结论：基线少肌症在接受TJA的患者中普遍存在。它与TKA和THA后UTI和假体松动的风险增加有关。输血风险增加,肺炎,假体骨折,TKA后机械松动。
结果：在全膝关节置换术（TKA）中，肌肉减少症的合并患病率为20.1％（95％CI[置信区间]13.6至28.8％；P<0.00001；I2=94.7％），在全髋关节置换术（THA）中为5.2％（95％CI0.1至69.7％；P=0.128；I2=99.6％）。元回归发现年龄之间没有联系，性别,体重指数（BMI），糖尿病,肥胖，关节成形术类型,TJA中的肌少症患病率。肌肉减少症增加输血风险（OR[比值比]4.68[95%CI3.51至6.25]；P<0.00001），肺炎（OR1.94[95%CI1.14至3.30]；P=0.01），尿路感染UTI(OR1.64[95%CI1.31to2.05];P<0.001),假体骨折（OR2.12[95％CI1.51至2.98]；P<0.0001），假体脱位（OR1.99[95％CI1.62至2.44]；P<0.00001），TKA中机械松动（OR1.78[95%CI1.43至2.22]；P<0.00001）。肌肉减少患者在THA后UTI(OR1.79[95%CI1.32至2.43];P=0.0002)和假体松动(OR1.97[95%CI1.10至3.53];P=0.02)的风险增加。
结论：基线少肌症在接受TJA的患者中普遍存在。它与TKA和THA后UTI和假体松动的风险增加有关。输血风险增加,肺炎,假体骨折,TKA后机械松动。
