循证医学：膝关节镜检查后行全膝置换，并发症发生率高吗？

来源：304关节学术

Total knee arthroplasty after a prior knee arthroscopy has higher complication rates: a systematic review

Purpose This article aimed to study in a systematic manner outcomes and complication rates after total knee arthroplasty (TKA) in patients who have undergone a prior knee arthroscopy for osteoarthritis. Our hypothesis was that a prior knee arthroscopy may be detrimental to the outcomes of knee arthroplasty in the future.

Methods Electronic searches were performed for all studies published before June 2020. We included studies in which at least one group had a non-ligament knee arthroscopy surgery prior to primary knee arthroplasty. MINORS (Methodological index for non-randomized studies) criteria was used to assess the methodological quality of all the studies.

Results Seven retrospective studies were included in the systematic review. The total number of TKA without prior arthroscopies was 138,630, and the total TKA after a prior arthroscopy was 4372. Of the five studies that reported functional outcomes, three studies reported no difference, whereas two studies reported worse outcomes in patients with a prior knee arthroscopy. Higher rates of prosthetic joint infection and overall complications were seen in patients with a prior knee arthroscopy.

Conclusion Total knee arthroplasty, when preceded by knee arthroscopy for osteoarthritis may lead to an increase in complication rates like prosthetic joint infections, revision, and re-operations. However, no significant differences were observed in patient-reported functional outcomes and range of joint motion. An association with postoperative complications after subsequent TKA should be a deterrent in advocating this procedure in an arthritic knee.

膝关节镜检查后行全膝关节置换术有

较高的并发症发生率：一项系统回顾

译者：沈松坡

目的：本文旨在以系统回顾的方式研究先前接受过膝关节镜治疗骨关节炎的患者在全膝关节置换术(TKA)后的结果和并发症发生率。我们的假设是，之前的膝关节镜检查可能对未来的膝关节置换术的结果有害。

方法：对2020年6月之前发表的所有研究进行电子检索。我们纳入研究的条件是至少一组患者在初次膝关节置换术前进行了非韧带相关膝关节镜手术。采用MINORS标准（非随机研究方法学指标）评估所有研究的方法学质量。

结果：共纳入7项回顾性研究。未接受关节镜检查的TKA总数为138,630例，接受关节镜检查的TKA总数为4372例。在报道功能性结果的5项研究中，3项研究报道无差异，而2项研究报道既往膝关节镜检查患者的预后较差。先前接受过膝关节镜检查的患者，假体关节感染和整体并发症的发生率较高。

结论：骨关节炎患者在全膝关节置换术前接受膝关节镜治疗，可能会增加关节假体周围感染、翻修和再次手术等并发症的发生率。然而，在患者报告的功能结果和关节活动范围没有观察到显著差异。由于在关节镜术后行TKA术后并发症发生率高的相关性，对于既往有过关节镜手术史的膝骨关节炎患者行TKA术应慎重。

文献出处：Goyal T, Tripathy SK, Schuh A, Paul S. Total knee arthroplasty after a prior knee arthroscopy has higher complication rates: a systematic review. Arch Orthop Trauma Surg. 2021 Sep 20. doi: 10.1007/s00402-021-04175-6. Epub ahead of print. PMID: 34542652.