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How long does a knee replacement last? A systematic review and meta-analysis of case series and national registry reports with more than 15 years of follow-up 膝关节置换能使用多长时间？对国家登记系统中 超过15年病例的系统回顾和Meta分析 译者：张轶超 BACKGROUND: Knee replacements are the mainstay of treatment for end-stage osteoarthritis and are effective. Given time, all knee replacements will fail and knowing when this failure might happen is important. We aimed to establish how long a knee replacement lasts. 背景：膝关节置换术是治疗晚期骨关节炎的主要而有效的方法。鉴于所有的膝关节置换都有失败的时候，因此知道什么时候失败是非常重要的。本文目的是确定膝关节置换能使用多长时间。 METHODS: In this systematic review and meta-analysis, we searched MEDLINE and Embase for case series and cohort studies published from database inception until July 21, 2018. Articles reporting 15 year or greater survival of primary total knee replacement (TKR), unicondylar knee replacement (UKR), and patellofemoral replacements in patients with osteoarthritis were included. Articles that reviewed specifically complex primary surgeries or revisions were excluded. Survival and implant data were extracted, with all-cause survival of the knee replacement construct being the primary outcome. We also reviewed national joint replacement registry reports and extracted the data to be analysed separately. In the meta-analysis, we weighted each series and calculated a pooled survival estimate for each data source at 15 years, 20 years, and 25 years, using a fixed-effects model. This study is registered with PROSPERO, number CRD42018105188. 方法：我们对从MEDLINE和EMBASE中检索出从数据库建立之初一直到2018年7月21日发表的病例序列和队列研究进行系统分析和Meta分析。选入了报告15年以上的初次全膝关节置换术（TKR）、单髁置换术（UKR）和髌股关节置换术生存率的文章。排除那些特别复杂的初次病例和翻修病例。收集了TKR的生存及假体数据，及全因生存率。我们也回顾分析了国家关节登记系统报告和收集的数据。在Meta分析中我们对每个系列数据进行了分析，采用固定影响模式分别在15年、20年和25年时对每个数据进行了汇集生存评估。本研究在PROSPERO注册，注册号为CRD42018105188。 FINDINGS: From 4363 references found by our initial search, we identified 33 case series in 30 eligible articles, which reported all-cause survival for 6490 TKRs (26 case series) and 742 UKRs (seven case series). No case series reporting on patellofemoral replacements met our inclusion criteria, and no case series reported 25 year survival for TKR. The estimated 25 year survival for UKR (based on one case series) was 72·0% (95% CI 58·0-95·0). Registries contributed 299 291 TKRs (47 series) and 7714 UKRs (five series). The pooled registry 25 year survival of TKRs (14 registries) was 82·3% (95% CI 81·3-83·2) and of UKRs (four registries) was 69·8% (67·6-72·1). 发现：在最初找到的4363个参考文献中，有30篇合乎要求的文章，包括33个病例序列，报告了6490例TKR（26个病例序列）和742例UKR（7个病例序列）的全因生存率。没有找到报告髌股关节置换的病例序列，也没有报告TKR25年的生存率的。25年UKR（1个病例序列）的生存率为72.0% (95% CI 58.0–95.0)。关节登记系统中找到299291例TKR（47个病例序列）和7714例UKR（5个病例序列）。TKR25年的汇集生存率为82.3% (95% CI 81.3–83.2)，UKR为69.8% (95% CI 67.6–72.1)。 INTERPRETATION: Our pooled registry data, which we believe to be more accurate than the case series data, shows that approximately 82% of TKRs last 25 years and 70% of UKRs last 25 years. These findings will be of use to patients and health-care providers; further information is required to predict exactly how long specific knee replacements will last. 解释：我们觉得关节登记系统的汇集生存率数据比文献报道的数据更准确，25年TKR的生存率接近82%，UKR接近70%。本发现对患者和医疗系统非常有用；下一步需要研究各种假体的准确生存时间。 骨科同道 购书支持 |
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