背景:金属超敏反应与全髋关节置换术(THA)和全膝关节置换术(TKA)后的持续症状有关,尽管关节置换成功。过敏经常同时发生,并与焦虑症等精神疾病有关。关于过敏的影响存在知识差距,包括金属过敏,THA和TKA后患者报告的结局指标(PROMs)。这项研究旨在评估包括金属超敏反应在内的过敏对THA和TKA患者PROM的影响。
方法:使用PubMed进行系统搜索PROSPERO(CRD42023475972),EMBASE,Scopus,和Cochrane数据库。包括比较接受原发性THA或TKA并报告PROM的过敏性和非过敏性成人的研究。使用MINORS标准评估方法学质量。计算具有95%置信区间(CI)的平均差异(MD)和标准化平均差异(SMD)。八项研究,涉及33,808名患者,包括在内。
结果:对于使用SF-12、SF-36、KOOSJR评估的功能结果,和HOOSJR,过敏患者的评分明显更差(SMD-0.23,95%CI-0.36至-0.09).WOMAC功能量表在过敏患者中也显示较差的结果(MD2.49,95%CI0.644.35)。对于使用WOMAC疼痛量表评估的疼痛,过敏患者报告疼痛显著更大(MD1.04,95%CI0.461.62).使用SF-12和SF-36评估的精神状态变化在两组之间没有显着差异(MD-0.46,95%CI-1.40至0.47)。在亚组分析中,THA亚组患者的预后显著较差(MD-7.20,95%CI-12.97--1.43).
结论:这项荟萃分析发现,过敏患者,包括金属过敏,THA和TKA后的功能结局通常比无过敏患者更差.需要进一步的研究来证实这些发现。术前过敏筛查可以识别有治疗优化风险的个体。
BACKGROUND: Metal hypersensitivity has been associated with persistent symptoms after total hip arthroplasty (THA) and total knee arthroplasty (TKA), despite successful joint replacement.
Allergies frequently co-occur and have been linked to psychiatric disturbances such as anxiety. There is a knowledge gap regarding the effect of
allergies, including metal hypersensitivity, on patient-reported outcome measures (PROMs) after THA and TKA. This study aimed to evaluate the influence of
allergies including metal hypersensitivity on PROMs in patients undergoing THA and TKA.
METHODS: A systematic search PROSPERO (CRD42023475972) was conducted using PubMed, EMBASE, Scopus, and Cochrane databases. Studies that compared allergic and non-allergic adults undergoing primary THA or TKA and reported PROMs were included. Methodological quality was assessed using the MINORS criteria. The mean differences (MD) and standardized mean differences (SMD) with 95% confidence intervals (CI) were calculated. Eight studies, involving 33,808 patients, were included.
RESULTS: For functional outcomes assessed using SF-12, SF-36, KOOS JR, and HOOS JR, allergic patients demonstrated significantly worse scores (SMD - 0.23, 95% CI -0.36 to -0.09). The WOMAC functional scale also demonstrated poorer results in allergic patients (MD 2.49, 95% CI 0.64 4.35). For pain assessed using the WOMAC pain scale, allergic patients reported significantly greater pain (MD 1.04, 95% CI 0.46 1.62). Changes in mental status assessed using the SF-12 and SF-36 did not show significant differences between the groups (MD -0.46, 95% CI -1.40 to 0.47). In subgroup analysis, patients in the THA subgroup showed significantly worse outcomes (MD -7.20, 95% CI -12.97 - -1.43).
CONCLUSIONS: This meta-analysis found that patients with
allergies, including metal hypersensitivity, generally had worse functional outcomes after THA and TKA than patients without
allergies. Further research is required to confirm these findings. Preoperative allergy screening can identify individuals at risk of treatment optimization.