Zusammenfassung
Hintergrund
Ein nicht zu unterschätzender Anteil von Patienten, die eine Kniegelenksendoprothese implantiert bekommen haben, ist unzufrieden oder klagt über persistierende Schmerzen nach der Operation.
Fragestellung
Es sollen die Häufigkeit von postoperativer Unzufriedenheit und persistierenden Schmerzen, bekannte Ursachen sowie Vorhersagewerte dargelegt werden.
Material und Methode
Die aktuelle Literatur zum Themenkomplex wird kritisch aufgearbeitet und narrativ wiedergegeben.
Ergebnisse
Ein Großteil der postoperativen Probleme ergab sich nicht aus operationstechnischen Details, sondern aus patientenspezifischen Merkmalen bzw. mangelnder präoperativer Aufklärung und Patientenselektion. Die Zufriedenheit korrelierte am stärksten mit der Reduktion des präoperativen Schmerzes.
Schlussfolgerung
Präoperativ sollte darauf geachtet werden, dass die Patienten ausschließlich Schmerzen im Kniegelenk mit klinisch und radiologisch fortgeschrittener Gonarthrose aufweisen, möglichst über 60 Jahre alt sind, ausreichend psychosoziale Ressourcen besitzen, um die Belastungen nach der Operation zu bewältigen, möglichst keine Opioide einnehmen und eine realistische Erwartung an das Knie nach der Operation besitzen. Postoperativ muss bei Patienten mit überdauernden Schmerzen der Ausschluss struktureller Ursachen erfolgen und der Zugang zu interdisziplinären Therapien ermöglicht werden, sollten keine strukturellen Gründe gefunden werden.
Abstract
Background
A substantial number of patients patients suffer from persistent pain or are unsatisfied after total knee arthroplasty (TKA).
Objectives
This work aims to present the frequency of postoperative persistent pain and/or dissatisfaction as well as known causes and predictors.
Materials and methods
The current literature is studied regarding the subject and is reviewed narratively.
Results
Most postoperative problems did not arise from operation details, but from patient-related criteria, a lack of patient education and selection. The satisfaction correlates most strongly with the reduction of preoperative pain.
Conclusion
For a successful TKA, care should be taken that the following aspects are met preoperatively: clinically and radiologically advanced osteoarthritis, a patient age preferably older than 60 years, sufficient psychosocial resources to cope with postoperative stress, no opioid medication and realistic expectations after TKA. Postoperatively, patients with persistent pain or dissatisfaction should be checked for any prosthesis-related problems. If no prosthesis-related problems could be detected, the patients should be referred for interdisciplinary therapies.
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F. Reichel, M. Innmann, T. Gotterbarm, M. Schiltenwolf und C. Merle geben an, dass kein Interessenkonflikt besteht.
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Reichel, F., Innmann, M., Gotterbarm, T. et al. Prädiktoren für persistierende Schmerzen und Unzufriedenheit nach Kniegelenksendoprothese. Schmerz 33, 185–190 (2019). https://doi.org/10.1007/s00482-019-0359-1
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DOI: https://doi.org/10.1007/s00482-019-0359-1