使用肾素-血管紧张素-醛固酮途径阻滞剂预防全膝关节置换术后关节纤维化的证据有限。临床证据的系统回顾。

IF 2 Q2 ORTHOPEDICS Journal of Experimental Orthopaedics Pub Date : 2024-12-11 DOI:10.1002/jeo2.70089

Giuseppe Anzillotti, Andreas H. Gomoll, Pietro Conte, Alberto Bulgarelli, Paolo Queirazza, Maurilio Marcacci, Elizaveta Kon, Berardo Di Matteo

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引用次数: 0

摘要

目的：尽管手术技术和康复方案取得了进步，但全膝关节置换术（TKA）后关节纤维化的预后仍然很差。在过去的十年中，人们的注意力一直集中在导致纤维化发展的发病机制和级联事件上。目前，最有希望的方法之一是通过下调肾素-血管紧张素-醛固酮系统（RAAS）间接拮抗转化生长因子β 1 （tgf - β 1）。本系统综述旨在分析血管紧张素受体阻滞剂(ARBs)/血管紧张素转换酶抑制剂（ACEi）用于预防TKA术后膝关节纤维化的现有证据。方法：于2024年7月8日对PubMed、Cochrane和谷歌Scholar数据库进行广泛研究，使用与arb、ACE抑制剂和关节纤维化相关的关键词。纳入标准包括：(1)任何证据水平的临床试验；（二）用英文书写的；（三）人体研究；(4)评估TKA手术中ACE抑制剂或arb的抗纤维化作用。排除标准是用其他语言写的文章；临床前研究;专家意见;评价与TKA后抗纤维化作用无关的ACEi/ arb效果的综述和试验。结果：共有6项研究符合纳入标准并进行了分析。所有研究均为回顾性研究，共涉及158,310例患者。在不同的研究中，给药时间和剂量各不相同，但都在心脏病学使用的范围内。六项研究中有四项专门针对氯沙坦。三项研究报告了使用arb和/或ACEi与降低发生关节纤维化的可能性之间明确且显著的相关性。结论：RAAS拮抗剂可能具有预防TKA术后僵硬的作用。然而，考虑到副作用和现有证据有限，目前不推荐将ACEi/sartans作为TKA后避免关节纤维化的唯一目的。证据等级：三级。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Limited evidence for the usage of renin–angiotensin–aldosterone pathway blockers to prevent arthrofibrosis after total knee arthroplasty. A systematic review of clinical evidence

Purpose

Despite advances in surgical techniques and rehabilitation protocols, arthrofibrosis following total knee arthroplasty (TKA) still has poor outcomes. In the last decade, attention has been focused on the pathogenesis and cascade of events leading to the development of fibrosis. Currently, one of the most promising approaches consists in the indirect antagonisation of transforming growth factor beta 1 (TGF-beta 1) through the downregulation of the renin–angiotensin–aldosterone system (RAAS). This systematic review aims to analyse the available evidence regarding the use of angiotensin receptor blockers (ARBs)/angiotensin-converting-enzyme inhibitors (ACEi) in order to prevent post-operative knee arthrofibrosis following TKA.

Methods

Extensive research on the PubMed, Cochrane, and Google Scholar databases was performed on 8 July 2024, using keywords related to ARBs, ACE inhibitors and arthrofibrosis. Inclusion criteria included: (1) clinical trials of any level of evidence; (2) written in English; (3) studies conducted on humans; and (4) evaluating the antifibrotic effects of ACE inhibitors or ARBs administered for TKA surgeries. Exclusion criteria were articles written in other languages; preclinical studies; expert opinions; reviews and trials evaluating the effects of ACEi/ARBs not related to their antifibrotic effect after TKA.

Results

A total of six studies met the inclusion criteria and were analysed. All studies were retrospective and involved a total of 158,310 patients. Time of administration varied among the studies as well as the dosage, which fell within the range for cardiological use. Four out of six studies focused exclusively on losartan. Three studies reported a clear, significant correlation between the use of ARBs and/or ACEi and a reduced likelihood of developing arthrofibrosis.

Conclusions

The RAAS antagonism could have potential for stiffness prevention after TKA. However, given the side effects and the limited evidence available, the use of ACEi/sartans for the sole purpose of avoiding arthrofibrosis after TKA is not currently recommended.