背景:镰状细胞病(SCD)患者的镰状红细胞引起的微血管阻塞可导致全髋关节置换术(THA)中术中和术后并发症增加。本系统综述和荟萃分析旨在评估SCD患者THA后并发症的总体发生率,并确定这些并发症的预测因素,包括手术方法。方法:在灰色文献中进行搜索,谷歌学者,和七个数据库:Scopus,MEDLINECentral/PubMed,ProQuest,SciELO,Sage,和WebofScience。纳入所有报告SCD中THA并发症比例的观察性研究。纽卡斯尔-渥太华量表质量评估工具用于评估研究质量。随机效应模型用于估计合并结果。对不同方法进行了亚组分析。使用敏感性分析和荟萃回归来解释异质性并确定THA并发症的预测因子。结果:在3230次引文中,只有23项研究符合荟萃分析的条件.SCD患者的总原发性THA并发症的合并比例为42%(95%CI:30-56%,I2=95%)。亚组分析强调了前外侧入路是并发症最少的入路。荟萃回归显示,前外侧入路可显著减少并发症,-28.67(95CI,-56.45--0.88,p=0.044),而髋关节数量增加了0.43(95CI,0.30-0.57,p<0.001)。男性,年龄,横向进近,和HbSS无显着影响SCD52.05、0.18、6.06和55.78的THA并发症。SCD危机的合并比例为9%(95CI,5-14%,I2=61%),位错4%(95CI:2-7%,I2=66%),无菌性松动12%(95CI,7-20%,I2=91%),修订6%(3-11,I2=92%),异位骨化12%(95CI,3-35%,I2=95%),和人工关节感染(PJI)6%(95CI,3-11%,I2=92%)。最拟合的元回归模型表明,HbSS显著增加PJI,0.05(95CI:0.02-0.08,p=0.009),男性性别和年龄没有显着增加PJI,2.28(95CI:-4.99-13.56,p=0.311)和0.001(95CI:-0.27-0.27,p=0.990),分别。同时,前外侧,横向,后路入路没有显着降低PJI,分别为-3.55、-0.92和-1.27。修订后镰状细胞疾病危机的合并比例为16%(95CI:6-36%,I2=0)和修正后无菌性松动,是24%(95CI:12-43%,I2=0)。结论:这项研究揭示了SCD患者的高并发症发生率,并强调了前外侧入路的并发症发生率最低。此外,这项研究表明,纯合(HbSS)个体更容易受到人工关节感染。
Background: Microvascular occlusions caused by sickle-shaped erythrocytes in patients with sickle cell disease (SCD) can lead to increased intraoperative and postoperative complications during total hip arthroplasty (THA). This systematic
review and meta-analysis aimed to estimate the overall rate of complications following THA in patients with SCD and to identify the predictors of these complications including the surgical approach. Methods: The search was conducted across the grey literature, Google Scholar, and seven databases: Scopus, MEDLINE Central/PubMed, ProQuest, SciELO, SAGE, and Web of Science. All observational studies reporting the proportional THA complications in SCD were included. The Newcastle-Ottawa Scale quality assessment tool was used to assess the quality of the studies. The random effect model was applied to estimate the pooled outcomes. A sub-group analysis for the different approaches was performed. A sensitivity analysis and meta-regression were used to explain heterogeneity and to identify the THA complication predictors. Results: Of 3230 citations, only 23 studies were eligible for the meta-analysis. The pooled proportion of total primary THA complications in patients with SCD was 42% (95% CI: 30-56%, I2 = 95%). The sub-group analysis highlighted the anterolateral approach as the approach accompanied with the least complications. The meta-regression revealed that the anterolateral approach decreases the complications significantly, -28.67 (95%CI, -56.45--0.88, p = 0.044), while the number of hips increased the complications by 0.43 (95%CI, 0.30-0.57, p < 0.001). Male gender, age, lateral approach, and HbSS non-significantly affect the THA complications in SCD 52.05, 0.18, 6.06, and 55.78, respectively. The pooled proportions for an SCD crisis 9% (95%CI, 5-14%, I2 = 61%), dislocation 4% (95%CI: 2-7%, I2 = 66%), aseptic loosening 12% (95%CI, 7-20%, I2 = 91%), revision 6% (3-11, I2 = 92%), heterotopic ossification 12% (95%CI, 3-35%, I2 = 95%), and prosthetic joint infection (PJI) 6% (95%CI, 3-11%, I2 = 92%). The most fitted model of meta-regression illustrated that HbSS significantly increases PJI, 0.05 (95%CI: 0.02-0.08, p = 0.009), and male gender and age non-significantly increase PJI, 2.28 (95%CI: -4.99-13.56, p = 0.311) and 0.001 (95%CI: -0.27-0.27, p = 0.990), respectively. Meanwhile, the anterolateral, lateral, and posterior approaches non-significantly decrease PJI, -3.55, -0.92, and -1.27, respectively. The pooled proportion for a sickle cell disease crisis after revision was 16% (95%CI: 6-36%, I2 = 0) and for aseptic loosening after revision, it was 24% (95%CI: 12-43%, I2 = 0). Conclusions: This study revealed the high rate of complications in patients with SCD and highlighted that the anterolateral approach was associated with the lowest rate of complications. Furthermore, this study illustrated that homozygous (HbSS) individuals are more susceptible to prosthetic joint infection.