Background: 

Orthostatic intolerance (OI)-type events following hip and knee arthroplasty increase the risk of falls, hospital length of stay, and health-care costs. There is a limited understanding of the incidence of and risk factors for OI-type events in patients during the acute hospital stay. Our aim was to systematically review the incidence of and risk factors for OI-type events during the acute hospital stay following hip and knee arthroplasty.

Methods: 

A systematic review and meta-analysis of studies that investigated the incidence of and risk factors for OI-type events was undertaken. A comprehensive search was performed in MEDLINE, Embase, and CINAHL from their inception to October 2021. The methodological quality of identified studies was assessed using the modified version of the Quality in Prognosis Studies (QUIPS) tool.

Results: 

Twenty-one studies (14,055 patients) were included. The incidence was 2% to 52% for an OI event, 1% to 46% for orthostatic hypotension, and 0% to 18% for syncope/vasovagal events. Two studies reported female sex, high peak pain levels (>5 out of 10) during mobilization, postoperative use of gabapentin, and the absence of postoperative intravenous dexamethasone as risk factors. There was no consensus on the definition and assessment of an OI-type event.

Conclusions: 

OI-type events are common during the acute hospital stay following hip and knee arthroplasty, and 4 risk factors have been reported for OI-type events. High-quality prospective cohort studies are required to systematically and reliably determine the incidence of and risk factors for OI-type events.

Level of Evidence: 

Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

中文翻译：

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髋关节和膝关节置换术后直立不耐受类事件：系统回顾和荟萃分析

背景： 

髋关节和膝关节置换术后的直立不耐受 (OI) 类事件会增加跌倒的风险、住院时间和医疗费用。对急性住院期间患者 OI 类事件的发生率和危险因素的了解有限。我们的目的是系统地回顾髋关节和膝关节置换术后急性住院期间 OI 类事件的发生率和危险因素。

方法： 

对调查 OI 类事件的发生率和危险因素的研究进行了系统回顾和荟萃分析。从 MEDLINE、Embase 和 CINAHL 开始到 2021 年 10 月，我们对其进行了全面搜索。使用预后研究质量 (QUIPS) 工具的修改版本评估了已确定研究的方法学质量。

结果： 

纳入了 21 项研究（14,055 名患者）。OI 事件的发生率为 2% 至 52%，直立性低血压事件的发生率为 1% 至 46%，晕厥/血管迷走神经事件的发生率为 0% 至 18%。两项研究报告了女性性别、动员期间的高峰值疼痛水平（> 10 次中的 5 次）、术后使用加巴喷丁以及术后未静脉注射地塞米松作为危险因素。对于 OI 类事件的定义和评估没有达成共识。

结论： 

OI 型事件在髋关节和膝关节置换术后的急性住院期间很常见，据报道有 4 个 OI 型事件的危险因素。需要高质量的前瞻性队列研究来系统、可靠地确定 OI 类事件的发生率和危险因素。

证据等级： 

预后等级 IV。有关证据等级的完整描述，请参阅作者须知。