RA患者关节置换术后并发症的风险高于OA

摘要 目的：目前大多数全髋关节置换术（THA）和全膝关节置换术（TKA）后并发症的研究数据来自于骨关节炎（OA）患者，而对于类风湿关节（RA）患者的情况知之甚少。本研究的目的是比较RA与OA行THA/TKA后并发症的情况。

方法：在Medline,、EMBase,、Cinahl,、Web of Science及文章参考文献列表中检索1990年至2011年发表的关于全髋或膝关节置换术的研究，包括超过200个RA及OA的关节。观察的结局包括校正、髋关节脱位、感染、90天死亡率和静脉血栓事件。两名评价者独立评估每一项研究的质量并提取数据，进行荟萃分析或定性评估证据水平。

结果：共入选40个研究。结果显示RA患者行THA后髋关节脱位的风险增加（校正风险比2.16[95%置信区间1.52-3.07]）。行TKA后，RA患者发生感染及早期矫正的风险也同样高于OA患者。THA或TKA后90天死亡率和静脉血栓风险在RA和OA中无差别。RA被明确定义的研究只有3项（7.5%），调整了共变量（如年龄、性别、合并症）的研究有11项（27.5%）。

结论：本次文献回顾及荟萃分析的结果表明，RA患者全髋关节置换术后髋关节脱位及全膝关节置换术后感染的风险高于OA。

附全文：Objective. Most of the evidence regarding complications following total hip arthroplasty (THA) and total knee arthroplasty (TKA) is based on studies of patients with osteoarthritis (OA), with little being known about outcomes in patients with rheumatoid arthritis (RA). The objective of the present study was to review the current evidence regarding rates of THA/TKA complications in RA versus OA. Methods. Data sources used were Medline, EMBase, Cinahl, Web of Science, and reference lists of articles. We included reports published between 1990 and 2011 that described studies of primary total joint arthroplasty of the hip or knee and contained information on outcomes in >200 RA and OA joints. Outcomes of interest included revision, hip dislocation, infection, 90-day mortality, and venous thromboembolic events. Two reviewers independently assessed each study for quality and extracted data. Where appropriate, meta-analysis was performed; if this was not possible, the level of evidence was assessed qualitatively.Results. Forty studies were included in this review. The results indicated that patients with RA are at increased risk of dislocation following THA (adjusted odds ratio 2.16 [95% confidence interval 1.52–3.07]). There was fair evidence to support the notion that risk of infection and risk of early revision following TKA are increased in RA versus OA. There was no evidence of any differences in rates of revision at later time points, 90-day mortality, or rates of venous thromboembolic events following THA or TKA in patients with RA versus OA. RA was explicitly defined in only 3 studies (7.5%), and only 11 studies (27.5%) included adjustment for covariates (e.g., age, sex, and comorbidity). Conclusion. The findings of this literature review and meta-analysis indicate that, compared to patients with OA, patients with RA are at higher risk of dislocation following THA and higher risk of infection following TKA.

摘自：Ravi B, Escott B, Shah PS, et al. A Systematic Review and Meta-Analysis Comparing Complications Following Total Joint Arthroplasty for Rheumatoid Arthritis Versus for Osteoarthritis. Arthritis Rheum. 2012, 64(12):3839-49.