Zeitschrift für Rheumatologie

, Volume 71, Issue 8, pp 670–679 | Cite as

Postoperatives Management nach Hüft- und Knieendoprothetik

Leitthema
First Online:

Zusammenfassung

Entzündliche Synovialerkrankungen gehen trotz systemischer medikamentöser Therapie oftmals mit schweren Destruktionen der großen und kleinen Gelenke einher, sodass vor allem am Knie- und Hüftgelenk bereits frühzeitig der endoprothetische Gelenkersatz notwendig wird. Dabei ist die Kenntnis der sich aus der Grunderkrankung ergebenen postoperativen Besonderheiten Voraussetzung für eine erfolgreiche chirurgische Behandlung. Während Luxationen der künstlichen Gelenkkomponenten bei Patienten mit rheumatoider Arthritis nicht vermehrt beobachtet werden, ist aufgrund von „disease modifying anti-rheumatic drugs“ (DMARDs) und Biologika das Infektionsrisiko jedoch per se erhöht. Hier gilt es, prä- und postoperativ die medikamentöse Therapie zu optimieren. Zur schnellen Wiedererlangung der Selbstständigkeit sollten physikalische Anwendungen und die krankengymnastische Beübung unter Zuhilfenahme von entsprechenden Hilfsmitteln frühestmöglich nach dem operativen Eingriff begonnen werden. Dazu ist bei Patienten mit entzündlichen Synovialerkrankungen die stationäre Rehabilitation anzustreben. Nur unter Berücksichtigung der speziellen Nachbehandlung nach endoprothetischem Gelenkersatz sind die Langzeitergebnisse vergleichbar mit denen von gesunden Patienten.

Schlüsselwörter

Postoperatives Management Endoprothese Rheumatoide Arthritis Physiotherapie Rehabilitation 

Postoperative management of hip and knee endoprostheses

Abstract

Rheumatoid arthritis is often accompanied by massive destruction of the smaller and larger joints even with early therapy using antirheumatic drugs. In these cases total joint arthroplasty is the only surgical option, especially for the knee and hip joint. Knowledge of the specific disease-related postoperative characteristics is a prerequisite for the successful treatment of patients with rheumatoid arthritis. As dislocation of the arthroplastic joint does not occur more often in rheumatoid arthritis, the risk of periprosthetic infection is increased due to the use of biologicals. Therefore, a perioperative optimization is obligatory. In order to facilitate independence in daily living physiotherapy in combination with aids such as arthritis crutches, gripping pliers or raised toilet seat need to be started as soon as possible after surgical treatment. To achieve this goal it is recommended to refer patients with inflammatory arthritis to inpatient rehabilitation facilities. With respect to the specific postoperative treatment after joint replacement the long-term results are comparable with those from patients with primary osteoarthritis.

Keywords

Postoperative management Joint replacement Rheumatoid arthritis Physiotherapy Rehabilitation 
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Notes

Interessenkonflikt

Der korrespondierende Autor gibt für sich und seinen Koautor an, dass kein Interessenkonflikt besteht.

Literatur

  1. 1.
    Institut für Qualität und Patientensicherheit BQS (2009) Bundesauswertung 2008 für Hüft- und Knie-Endoprothesenerstimplantation. http://www.bqs-outcome.de/2008“ www.bqs-outcome.de/2008Google Scholar
  2. 2.
    Rehart S, Henniger M (2011) Endoprothetik am Hüftgelenk. Z Rheumatol 70:406–410PubMedCrossRefGoogle Scholar
  3. 3.
    Cross-sectional guidelines for therapy with blood components and plasma derivatives. Published by: The Board of the German Medical Association on the Recommendation of the Scientific Advisory Board (Bundesaerztekammer). Special topic issue: transfusion medicine and hemotherapy 2009, Vol. 36, No. 6Google Scholar
  4. 4.
    Reilly TJ, Gradisar IA Jr, Pakan W, Reilly M (1986) The use of postoperative suction drainage in total knee arthroplasty. Clin Orthop Relat Res 238–242Google Scholar
  5. 5.
    Esler CN, Blakeway C, Fiddian NJ (2003) The use of a closed-suction drain in total knee arthroplasty. A prospective, randomised study. J Bone Joint Surg Br 85:215–217PubMedCrossRefGoogle Scholar
  6. 6.
    Gonzalez Della Valle A, Slullitel G, Vestri R et al (2004) No need for routine closed suction drainage in elective arthroplasty of the hip: a prospective randomized trial in 104 operations. Acta Orthop Scand 75:30–33CrossRefGoogle Scholar
  7. 7.
    Li C, Nijat A, Askar M (2010) No clear advantage to use of wound drains after unilateral total knee arthroplasty: a prospective randomized, controlled trial. J Arthroplasty 26:519–522PubMedCrossRefGoogle Scholar
  8. 8.
    Brander V, Stulberg SD (2006) Rehabilitation after hip- and knee-joint replacement. An experience- and evidence-based approach to care. Am J Phys Med Rehabil 85:98–118 (quiz 9–23)CrossRefGoogle Scholar
  9. 9.
    Doran MF, Crowson CS, Pond GR et al (2002) Frequency of infection in patients with rheumatoid arthritis compared with controls: a population-based study. Arthritis Rheum 46:2287–2293PubMedCrossRefGoogle Scholar
  10. 10.
    Patel VP, Walsh M, Sehgal B et al (2007) Factors associated with prolonged wound drainage after primary total hip and knee arthroplasty. J Bone Joint Surg Am 89:33–38PubMedCrossRefGoogle Scholar
  11. 11.
    Ahmed AA, Mooar PA, Kleiner M et al (2011) Hypertensive patients show delayed wound healing following total hip arthroplasty. PLoS One 6(8):e23224PubMedCrossRefGoogle Scholar
  12. 12.
    Stralen GM van, Struben PJ, Loon CJ van (2003) The incidence of dislocation after primary total hip arthroplasty using posterior approach with posterior soft-tissue repair. Arch Orthop Trauma Surg 123:219–222PubMedGoogle Scholar
  13. 13.
    Woo RY, Morrey BF (1982) Dislocations after total hip arthroplasty. J Bone Joint Surg Am 64:1295–1306PubMedGoogle Scholar
  14. 14.
    Rittmeister M, Schwinnen I, Rehart S, Kerschbaumer F (2002) Hüftgelenkersatz bei rheumatischer und degenerativer Erkrankung. Ein Vergleich perioperativer Variablen. Orthopade 31:1168–1174PubMedCrossRefGoogle Scholar
  15. 15.
    Grennan DM, Gray J, Loudon J, Fear S (2001) Methotrexate and early postoperative complications in patients with rheumatoid arthritis undergoing elective orthopaedic surgery. Ann Rheum Dis 60:214–217PubMedCrossRefGoogle Scholar
  16. 16.
    Fuerst M, Mohl H, Baumgartel K, Ruther W (2006) Leflunomide increases the risk of early healing complications in patients with rheumatoid arthritis undergoing elective orthopedic surgery. Rheumatol Int 26:1138–1142PubMedCrossRefGoogle Scholar
  17. 17.
    Smitten AL, Choi HK, Hochberg MC et al (2008) The risk of hospitalized infection in patients with rheumatoid arthritis. J Rheumatol 35:387–393PubMedGoogle Scholar
  18. 18.
    Akkara Veetil BM, Bongartz T (2011) Perioperative care for patients with rheumatic diseases. Nat Rev Rheumatol 8:32–41CrossRefGoogle Scholar
  19. 19.
    Howe CR, Gardner GC, Kadel NJ (2006) Perioperative medication management for the patient with rheumatoid arthritis. J Am Acad Orthop Surg 14:544–551PubMedGoogle Scholar
  20. 20.
    Nurmohamed MT, Lems WF, Dijkmans BA (1999) Risk of post-discharge venous thromboembolism in patients with rheumatoid arthritis undergoing knee or hip arthroplasty. Is prolonged thromboprophylaxis warranted or dangerous? Ann Rheum Dis 58:392–395PubMedCrossRefGoogle Scholar
  21. 21.
    Drenkard C, Villa AR, Alarcon-Segovia D, Perez-Vazquez ME (1994) Influence of the antiphospholipid syndrome in the survival of patients with systemic lupus erythematosus. J Rheumatol 21:1067–1072PubMedGoogle Scholar
  22. 22.
    Leclerc JR, Gent M, Hirsh J et al (1998) The incidence of symptomatic venous thromboembolism during and after prophylaxis with enoxaparin: a multi-institutional cohort study of patients who underwent hip or knee arthroplasty. Canadian Collaborative Group. Arch Intern Med 158:873–878PubMedCrossRefGoogle Scholar
  23. 23.
    Leitlinie S (2009) Prophylaxe der venösen Thromboembolie (VTE). AWMF Leitlinie. http://www.awmf-leitlinien.deGoogle Scholar
  24. 24.
    Chelly JE, Greger J, Gebhard R et al (2001) Continuous femoral blocks improve recovery and outcome of patients undergoing total knee arthroplasty. J Arthroplasty 16:436–445PubMedCrossRefGoogle Scholar
  25. 25.
    Capdevila X, Barthelet Y, Biboulet P et al (1999) Effects of perioperative analgesic technique on the surgical outcome and duration of rehabilitation after major knee surgery. Anesthesiology 91:8–15PubMedCrossRefGoogle Scholar
  26. 26.
    Singelyn FJ, Gouverneur JM (1999) Postoperative analgesia after total hip arthroplasty: I.V. Pca with morphine, patient-controlled epidural analgesia, or continuous „3-in-1“ Block? A prospective evaluation by our acute pain service in more than 1,300 patients. J Clin Anesth 11:550–554PubMedCrossRefGoogle Scholar
  27. 27.
    Minor MA, Hewett JE, Webel RR et al (1989) Efficacy of physical conditioning exercise in patients with rheumatoid arthritis and osteoarthritis. Arthritis Rheum 32:1396–1405PubMedCrossRefGoogle Scholar
  28. 28.
    McInnes J, Larson MG, Daltroy LH et al (1992) A controlled evaluation of continuous passive motion in patients undergoing total knee arthroplasty. JAMA 268:1423–1428PubMedCrossRefGoogle Scholar
  29. 29.
    Mahomed NN, Davis AM, Hawker G et al (2008) Inpatient compared with home-based rehabilitation following primary unilateral total hip or knee replacement: a randomized controlled trial. J Bone Joint Surg Am 90:1673–1680PubMedCrossRefGoogle Scholar
  30. 30.
    Bandholm T, Kehlet H (2012) Physiotherapy exercise after fast-track total hip and knee arthroplasty: time for reconsideration? Arch Phys Med Rehabil 93(7):1292–1294PubMedCrossRefGoogle Scholar
  31. 31.
    Munin MC, Kwoh CK, Glynn N et al (1995) Predicting discharge outcome after elective hip and knee arthroplasty. Am J Phys Med Rehabil 74:294–301PubMedCrossRefGoogle Scholar
  32. 32.
    Shih CH, Du YK, Lin YH, Wu CC (1994) Muscular recovery around the hip joint after total hip arthroplasty. Clin Orthop Relat Res 115–120Google Scholar
  33. 33.
    Jerosch J, Heisel J (2010) Perioperatives Management beim endoprothetischen Hüftgelenkersatz. Das funktionelle interdisziplinäre Therapie- (fitTM-)Konzept. Unfallchirurg 113:6–13PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  1. 1.Klinik für Orthopädie und Orthopädische RheumatologieKlinikum Bad BramstedtBad BramstedtDeutschland
  2. 2.Klinik und Poliklinik für OrthopädieUniversitätsklinikum Hamburg EppendorfHamburgDeutschland

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