| BackgroundHip and knee joint replacement is the clinical application of the most artificial joints, total hip and knee replacement surgery is already a fairly mature surgical treatment of various diseases caused by the severe joint pain, instability and deformity, after Poor non-surgical treatment results more precise. Much has been reported at home and abroad, now that the total hip replacement 20 years more than 80% success rate, artificial knee replacement more than 15 years of clinical good rate of up to 90%. But the multi-joint replacement in the same period reported fewer earlier that Ritter and other foreign countries in 1976 reported 15 cases of bilateral total hip joint replacement surgery, joint replacement and internal reports on the many 20th century began in the early 90s, Lu equal to 1993, reported over 30 cases of simultaneous bilateral knee replacement surgery, with surgical technology continues to mature, domestic and foreign has gradually began to expand the applications. Involving more than three joint replacement, less foreign coverage article. Only two reported cases of domestic analysis. Almost all of the reports have proved that multi-joint surgery and staging surgery over the same period of comparison, can shorten the hospital stay, reduce hospital costs, preoperative preparation only once, fewer anesthesia, surgery can reduce patient over the same period the financial burden and psychological burden, to facilitate early postoperative exercise significantly shorten the recovery period. Disadvantage is more than the same period in joint replacement surgeries, surgery is relatively difficult to have increased, operative duration, postoperative bleeding increased patient against large demands on the choice of cases is relatively high, the need for better tolerance, another of the surgeon's experience and skill requirements are also relatively high. Currently the feasibility of multi-joint replacement is still a lot of controversy. In this study, use of evidence-based medicine approach to analysis of the current relevant literature on multi-joint (three joints or more) replacement therapy safety and efficacy of an objective system of evaluation. In order to provide some evidence-based clinical study evidence.Purpose1.Multi-joint system evaluation period (three joints or more) replacement (Simultaneous Multiple Joint Replacement) and staging of multiple joint replacement (Multiple Joint Replacement by Stages) treatment of the clinical efficacy of bone and joint disease.2.Systematic reviews more than the same period in treatment of osteoarthritis joint replacement security.3.Systematic review of minimally invasive total hip arthroplasty with conventional total hip replacement surgery clinical effects.Method1. According to different research purposes,by PICO program(Partici-pant,Intervention, Comparator, Outcome) to develop appropriate detailed inclusion and exclusion criteria (including study characteristics, interventions and outcome indicators of measurement), while the development of these standards according to a systematic and comprehensive search strategy, the chosen design type of literature randomized controlled trials at home and abroad (Randomized Controlled Trials, RCTs), controlled clinical trials (controlled clinical trials, CCT), quasi-randomized controlled trials (Quasi Randomized Controlled Trials, Quasi-RCTs), cohort study (cohort study), case-control study (case-control studies), systematic review (systematic review), not limited to language and area studies.2. Searched Cochrane Library, Medline database, Embase database, Chinese Biomedical Literature Database, the Chinese Journal Full-text databases and full text database of VIP, hand searched reference lists of documents and four kinds of Chinese major Orthopaedics. Collected and screened met the inclusion and exclusion criteria of RCTs, Quasi-RCTs, cohort studies, case-control research literature. Including multi-year multi-stage joint replacement and joint replacement in the treatment of lower limb joint disease RCTs, Quasi-RCTs and cohort studies and other articles; minimally invasive total hip arthroplasty with conventional total hip arthroplasty clinical effects of RCT articles.3. In accordance with the randomized controlled trial of quality evaluation standard of rigorous evaluation of all relevant methodological quality of included studies, assessment of entries include stochastic methods, random allocation concealment, blinding, description of implementation and lost. All included in the study of authenticity according to Jadad quality assessment form to evaluate, write,1-3 were divided into 1-7 sub-divided into low-quality,4-7 quality.4. After strict quality assessment of collected data of all relevant research data extraction, the main outcome measures of data is extracted by providing the RevMan5.0 Cochrane Collaboration Meta analysis of statistical software. Count data using relative risk (Relative Risk, RR), said measurement data using the weighted mean difference (Weighted Mean Difference, WMD) that both give 95% confidence interval (Confidence Interval, CI). The study combined analysis of clinical heterogeneity before, if the interventions were different, with subgroup analysis. Statistical heterogeneity between studies using Chi-square test to test the level of a= 0.1. When no statistical heterogeneity a fixed effect model. If there is statistical heterogeneity, the random effects model analysis. Quantitative synthesis that can not row or a very low incidence of measurement indicators, the qualitative assessment by describing.ResultsLA preoperative anesthesia assessment is closely related with the death factor is consciousness status,functional class, ASA assessment of renal dysfuntion. The results showed that:consciousness of death in patients with poor probability of occurrence is the mind of 5.453 times in patients without abnormal; cardiac dysfunction in patients with risk of death is unintentional function in patients with 9.564 times; ASA assessment of probability of death in patients with abnormal is normal in patients with 6.234-fold; patients with renal dysfunction in patients likely to die of 9.623 times the normal.2 year multi-stage multi-joint replacement and joint replacement in the mortality rate was not statistically significant; After 3 years of follow-up. The results show:the total number of cases is 1321 cases, 162 cases of death, deathRate of 12.26%. Which accounted for 48.77 percent infection, cerebral vascular accident accounted for 24.07%, congestive heart failure Accounting for 9.26%, accounting for 8.02% of renal failure, cancer accounted for 5.56%, CSM was 3.08%, the highest Traumatic cervical spine fracture and the second accounted for 1.23%; Four pairs of patients after joint replacement over the same period followed up for five years after surgery, ten, fifteen years. Survival curves by survival prognosis can be made a preliminary assessment:the first 5-year survival rate after surgery 90%, 10-year survival rate of 71%,15-year survival rate of 48%. Years survival rate is very obvious.5 year multi-joint replacement group stages and more blood loss than joint replacement group, significant statistical significance.6 more than the same period in hemoglobin decreased after joint replacement value of the score of multi-joint replacement group was, significantly statistically significant.7 multi-joint replacement surgery over the same period of time the score of multiple joint replacement surgery to be a long time, with significant statistical significance. 8-year multi-joint replacement group preoperative Harris hip replacement rates and stage more joint replacement was no significant difference; over the corresponding period of the hip joint replacement arthroplasty Harris score and staging of multi-joint replacement group, significant differences the same period, multi-joint replacement group is superior to stage more joint replacement.9 more than the same period of preoperative joint replacement Knee Hss score and staging of multiple joint replacement was no significant difference; over the same period after knee joint replacement group Hss score and staging of multi-joint replacement group there were significant differences in the same period Hss knee joint replacement surgery more than staging score more than joint replacement.10 Kapu Lan-Meyer prognosis of daily walking ability curve shows:92% the first year after surgery in patients with normal gait,79% of patients 10 years of normal gait, only 60% of patients 15 years of normal gait. More than the same period in daily life after joint replacement group walking ability (ADL) and multi-stage joint replacement was no significant statistical significance.11 more than the same period the total joint replacement group the incidence of complications after surgery and staging of multiple joint replacement was no significant statistical significance, that the total postoperative complication rate did not improve significantly. Knee pain, hip pain, dislocation, myositis ossificans, pressure ulcer, hematoma, fracture, prosthesis loosening, wound healing of the P values were greater than 0.05, indicating more than the same period in joint replacement and joint replacement more than two phases the incidence of complications in the above rate no significant difference; infection and DVT of the P value was less than 0.05, indicating a significant difference between the two groups, more than the same period of Shuhou joint replacement infections and the high incidence of DVT in the Fen Multiple joint replacement.12-year multi-joint replacement group stages of hospital cost is lower than the multi-joint replacement group, significant statistical significance.13 minimally invasive total hip arthroplasty and total hip arthroplasty of perioperative complications between was no significant difference. From the specific factors to consider, minimally invasive hip replacement prosthesis around the fracture rate in a traditional hip replacement, P value <0.05; the dislocation and complications of internal diseases, were significantly lower than the latter. The other complications such as:infection, DVT, hematoma, implant loosening, and skin necrosis between the two groups no significant difference, P value> 0.05.14 patients after minimally invasive total hip pain than traditional total hip replacement pain mild, statistically significant differences. Minimally invasive total hip arthroplasty, the patient's function has been significantly improved, the majority of patients 3 months after the Harris score was 90 points were more than satisfied with the joints of patients than traditional total hip replacement operation. Conclusion1.A preoperative anesthesia assessment is closely related with the death factor is consciousness status, functional class, ASA assessment of renal dysfunction. The results showed that:consciousness of death in patients with poor probability of occurrence is the mind of 5.453 times in patients without abnormal; cardiac dysfunction in patients with risk of death is unintentional function in patients with 9.564 times; ASA assessment of probability of death in patients with abnormal is normal in patients with 6.234-fold; patients with renal dysfunction in patients likely to die of 9.623 times the normal.2 year multi-stage multi-joint replacement and joint replacement in the mortality rate was not statistically significant; after years of follow-up, total mortality in the first infection, cerebrovascular accidents ranked second, heart, kidney failure, third.90% 5-year survival rate after 10-year survival rate of 71%,15-year survival rate of 48%. Years survival rate is very obvious.3 year multi-joint replacement group stages and more blood loss than joint replacement, joint replacement surgery over the same period in hemoglobin values scores down significantly on the multi-joint replacement, joint replacement surgery over the same period of time the score of multiple joint replacement surgery longer time, more than the same period in joint replacement group hospitalization costs lower than many joint replacement phases.4 before hip replacement surgery, joint replacement group over the same period in Harris scores and stage more joint replacement was no significant difference; postoperative Harris scores over the same period in joint replacement group is superior to staging and more joint replacement.5 before knee replacement surgery, joint replacement group over the same period Hss score and staging of multiple joint replacement was no significant difference; Hss knee scores, knee arthroplasty over the same period Hss score better than the multi-stage joint replacement.6 more than the same period in daily life after joint replacement group walking ability (ADL) and staging of multiple joint replacement was no significant difference.92% of patients after five years of normal gait,79% of patients after 10 years of normal gait, after 15 years only 60% of patients had a normal gait.7 more than the same period the total joint replacement group the rate of complications after surgery and staging of the whole multi-joint replacement group were the incidence of complications is not significantly different. Univariate analysis, more than the same period of infection after joint replacement group, and deep vein thrombosis (DVT) in installments over the high incidence of joint replacement.8 minimally invasive total hip arthroplasty group and the traditional total hip arthroplasty group operative complications were no significant differences. From the specific factors to consider, minimally invasive hip replacement prosthesis around the fracture rate in a traditional hip replacement; the dislocation and complications of internal diseases, were significantly lower than the latter. And other complications, such as:infection, DVT, hematoma, implant loosening, and skin necrosis, the two groups showed no difference.9 minimally invasive total hip surgery patients in pain than traditional total hip replacement light pain, minimally invasive total hip arthroplasty group were better hip function. Minimally invasive total hip arthroplasty in patients satisfaction with the joints than traditional total hip replacement.10 With the incorporation of a limited number of studies, it is necessary to improve the long-term follow-up at the same time for more high quality, large sample randomized controlled trials (RCTs), to increase the strength of the evidence.
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