■无菌性松动是全膝关节置换术(TKA)后最常见的原因。尽管许多研究探索了与无菌性松动相关的各种风险因素,调查结果往往存在不一致之处。为了解决这个问题,我们对文献进行了全面回顾,以确定和分析水泥TKA的这些危险因素.此外,我们进行了荟萃分析,以调和各研究观察到的不同结论.
■我们搜索了PubMed,WebofScience和Embase从1996年到2024年,并评估了纳入文献的质量。纳入了74项研究来评估BMI的相关性,糖尿病,高体力活动(HPA),骨质疏松,类风湿性关节炎(RA),水泥材料和种植体设计。29项研究用于计算相对风险和CI(使用随机效应理论),并研究六种不同风险因素的异质性(BMI,糖尿病,HPA等级,水泥材料,聚乙烯和植入物设计)。
■与没有糖尿病的患者相比,糖尿病患者发生无菌性松动的可能性要高8倍(RR=9.18,95%CI:1.80-46.77,p<0.01)。使用胫骨杆延伸或高度交联的聚乙烯可以帮助减少无菌性松动的发生率。然而,我们没有确定BMI,HPA,骨质疏松,RA,使用高粘度水泥和使用移动轴承设计作为水泥后TKA无菌性松动的危险因素。
■接受TKA的糖尿病患者应就其无菌性松动的潜在风险增加进行咨询。使用胫骨干延长和HXLPE可以减轻骨水泥TKA中无菌性松动的发生率。然而,鉴于荟萃分析中包含的研究数量有限,我们认为,更高层次的研究是必要的,以明确确定其他风险因素。
■三级。
UNASSIGNED: Aseptic loosening is the most common cause for revisions after total knee arthroplasty (TKA). Despite many studies exploring various risk factors associated with aseptic loosening, findings often present inconsistencies. To address this, we conducted a thorough review of the literature to identify and analyse these risk factors in cemented TKA. Additionally, we performed a meta-analysis to reconcile the divergent conclusions observed across studies.
UNASSIGNED: We searched PubMed, Web of Science and Embase from 1996 up to 2024 and evaluated the quality of the included literature. Seventy-four studies were included to assess the association of BMI, diabetes, high physical activity (HPA), osteoporosis, rheumatoid arthritis (RA), cement material and implant design. Twenty-nine studies were used to calculate relative risk and CIs (using the random effects theory) and study heterogeneity for six different risk factors (BMI, diabetes, HPA level, cement material, polyethylene and implant design).
UNASSIGNED: Patients with diabetes are eight times more likely to experience aseptic loosening compared to those without diabetes (RR = 9.18, 95% CI: 1.80-46.77, p < 0.01). The use of tibial stem extension or highly crosslinked polyethylene can help reduce the incidence of aseptic loosening. However, we did not identify BMI, HPA, osteoporosis, RA, the use of high-viscosity cement and the utilization of mobile-bearing designs as risk factors for aseptic loosening post-cemented TKA.
UNASSIGNED: Patients with diabetes undergoing TKA should be counselled regarding their potential increased risk of aseptic loosening. The use of tibial stem extensions and HXLPE can mitigate the incidence of aseptic loosening in cemented TKA. However, given a limited number of studies were included in the meta-analysis, we believe that higher-level studies are necessary to clearly identify other risk factors.
UNASSIGNED: Level III.