镰状细胞病的全髋关节置换术：功能结局和并发症的系统回顾和荟萃分析

Q2 Medicine

Journal of Clinical Orthopaedics and Trauma Pub Date : 2025-05-13 DOI:10.1016/j.jcot.2025.103060

Ankush Mohabey , Jomon De Joseph , Felista Karen Joseph , Kalyani Deshmukh , Prajakta Warjukar , Aravind P. Gandhi

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引用次数: 0

摘要

背景镰状细胞病（SCD）是股骨头缺血性坏死（AVN）的重要危险因素，与原发性骨关节炎患者相比，通常需要在较年轻的年龄进行全髋关节置换术（THA）。本系统综述和荟萃分析旨在评估接受THA的SCD患者的功能结局、手术并发症和术中出血量。材料与方法于2024年11月5日对Cochrane、Web of Science、Scopus、EMBASE、PubMed等数据库进行了系统检索。包括镰状细胞患者行THA的研究。功能结果使用评分系统进行评估，如牛津髋关节评分（OHS）和哈里斯髋关节评分（HHS）。分析了术后并发症、翻修率和术中出血量。进行统计分析以得出汇总估计和置信区间。普洛斯彼罗id: crd42024609360。结果共有25项研究符合纳入标准，包括回顾性和前瞻性研究。合并分析显示功能预后有显著改善，HHS平均增加6.96 （95% CI: 5.56-8.35）。患者平均年龄20 ~ 35岁。合并估计的并发症包括无菌性松动（12%）、脱位（1%）、异位骨化（8%）、医源性骨折（8%）、感染（8%）、骨溶解（8%）、假体周围骨折（8%）、翻修手术（11%）、镰状细胞危象（5%）和血栓栓塞（2%）。结论在镰状细胞患者中，tha具有相当大的挑战，并发症风险高。尽管存在这些挑战，但THA可以改善功能。考虑到高风险，多学科围手术期护理策略对于优化预后至关重要。

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Total hip arthroplasty in sickle cell disease: A systematic review and meta-analysis of functional outcomes and complications

Background

Sickle cell disease (SCD) is a significant risk factor for avascular necrosis (AVN) of the femoral head, often necessitating total hip arthroplasty (THA) at a younger age than patients with primary osteoarthritis. This systematic review and meta-analysis aimed to evaluate the functional outcomes, surgical complications, and intraoperative blood loss in SCD patients undergoing THA.

Materials and methods

A systematic search of databases, including Cochrane, Web of Science, Scopus, EMBASE, and PubMed, was conducted on November 5, 2024. Studies involving sickle cell patients who underwent THA were included. Functional outcomes were assessed using scoring systems such as the Oxford Hip Score (OHS) and Harris Hip Score (HHS). Postoperative complications, revision rates, and intraoperative blood loss were also analyzed. Statistical analyses were conducted to derive pooled estimates and confidence intervals. PROSPERO ID: CRD42024609360.

Results

A total of 25 studies met the inclusion criteria, comprising both retrospective and prospective studies. The pooled analysis revealed a significant improvement in functional outcomes, with a mean HHS increase of 6.96 (95 % CI: 5.56–8.35). Mean age of patients ranged from 20 to 35 years. Pooled estimate of complications included aseptic loosening (12 %), dislocation (1 %), heterotopic ossification (8 %), iatrogenic fracture (8 %), infection (8 %), osteolysis (8 %), periprosthetic fractures (8 %), revision surgery (11 %), sickle cell crisis (5 %), and thromboembolism (2 %). The mean blood loss was 1059.24 ml.

Conclusion

THA in sickle cell patients presents considerable challenges with a high risk of complications. Despite these challenges, THA can lead to functional improvement. Given the heightened risk profile, multidisciplinary perioperative care strategies are essential to optimize outcomes.

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来源期刊

Journal of Clinical Orthopaedics and Trauma Medicine-Orthopedics and Sports Medicine

CiteScore

4.30

自引率

0.00%

发文量

181

审稿时长

92 days

期刊介绍： Journal of Clinical Orthopaedics and Trauma (JCOT) aims to provide its readers with the latest clinical and basic research, and informed opinions that shape today''s orthopedic practice, thereby providing an opportunity to practice evidence-based medicine. With contributions from leading clinicians and researchers around the world, we aim to be the premier journal providing an international perspective advancing knowledge of the musculoskeletal system. JCOT publishes content of value to both general orthopedic practitioners and specialists on all aspects of musculoskeletal research, diagnoses, and treatment. We accept following types of articles: • Original articles focusing on current clinical issues. • Review articles with learning value for professionals as well as students. • Research articles providing the latest in basic biological or engineering research on musculoskeletal diseases. • Regular columns by experts discussing issues affecting the field of orthopedics. • "Symposia" devoted to a single topic offering the general reader an overview of a field, but providing the specialist current in-depth information. • Video of any orthopedic surgery which is innovative and adds to present concepts. • Articles emphasizing or demonstrating a new clinical sign in the art of patient examination is also considered for publication. Contributions from anywhere in the world are welcome and considered on their merits.