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Gelenkersatz des älteren Menschen

Joint replacement in the elderly

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Zusammenfassung

Beim Gelenkersatz des älteren Menschen gilt es, Besonderheiten zu beachten. Angefangen von der Indikationsstellung, der präoperativen Vorbereitung, der Implantatauswahl bis hin zur intraoperativen Technik, Nachbehandlung sowie zu den klinischen Ergebnissen, zeigen sich teils erhebliche Unterschiede zu jüngeren Patienten. Aufgrund der deutlichen Diskrepanz zwischen chronologischem und biologischem Alter beim älteren Menschen, verbunden mit dem Aktivitätsniveau und dem Anspruch an das Kunstgelenk, ist es wichtig, das Vorgehen individuell auf den Patienten abzustimmen. Ungeachtet des Patientenalters stehen sämtliche Endoprothesenmodelle mit den implantatspezifischen Eigenschaften, die es zu beachten gilt, zur Verfügung. Zusammenfassend stehen beim älteren Menschen Attribute wie Stabilität und Schmerzfreiheit im Vordergrund.

Abstract

Special characteristics must be taken into consideration for replacement arthroplasty in the elderly. The indications, preoperative preparation, postoperative care, implant selection, intraoperative technique, as well as clinical results reveal sometimes substantial differences compared to younger patients. Based on these findings it is important to individualize the approach to patient therapy, especially due to distinct differences between chronological and biological age in the elderly, in association with the level of activity and expectations on the new joint. All types of implants, each with implant-specific characteristics that must be taken into consideration, are available independent of the age of the patient. In summary, attributes such as stability and pain-free mobility have to be given priority in the elderly.

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Literatur

  1. S1-Leitlinie „Endoprothese bei Coxarthrose“. http://www.awmf.org/uploads/tx_szleitlinien/012-006l_S1_Endoprothese_bei_Koxarthrose_abgelaufen.pdf. Zugegriffen: 08.12.2016

  2. S1-Leitlinie „Endoprothese bei Gonarthrose“. http://www.awmf.org/uploads/tx_szleitlinien/012-008_S1_Endoprothese_bei_Gonarthrose_2009_abgelaufen.pdf. Zugegriffen: 08.12.2016

  3. Tilbury C, Haanstra TM, Leichtenberg CS, Verdegaal SH, Ostelo RW, de Vet HC, Nelissen RG, Vliet Vlieland TP (2016) Unfulfilled expectations after total hip and knee arthroplasty surgery: there is a need for better preoperative patient information and education. J Arthroplasty. doi:10.1016/j.arth.2016.02.061

    PubMed  Google Scholar 

  4. Ghomrawi HM, Mancuso CA, Westrich GH, Marx RG, Mushlin AI, Expectations Discordance Study Group (2013) Discordance in TKA expectations between patients and surgeons. Clin Orthop Relat Res 471(1):175–180. doi:10.1007/s11999-012-484-3

    Article  PubMed  Google Scholar 

  5. Versorgungsstärkungsgesetz. http://www.bmg.bund.de/themen/krankenversicherung/gkv-versorgungsstaerkungsgesetz.html. Zugegriffen: 08.12.2016

  6. Müller A, Lachmann G, Wolf A, Mörgeli R, Weiss B, Spies C (2016) Peri- and postoperative cognitive and consecutive functional problems of elderly patients. Curr Opin Crit Care 22:406. doi:10.1097/mcc.0000000000000327

    Article  PubMed  Google Scholar 

  7. Santaguida PL, Hawker GA, Hudak PL, Glazier R, Mahomed NN, Kreder HJ, Coyte PC, Wright JG (2008) Patient characteristics affecting the prognosis of total hip and knee joint arthroplasty: a systematic review. Can J Surg 51(6):428–436

    PubMed  PubMed Central  Google Scholar 

  8. Waydas C (2014) Orthopädie und Unfallchirurgie. Mitt Nachr 2:146–150

    Google Scholar 

  9. Schwab PE, Lavand’homme P, Yombi J, Thienpont E (2015) Aspirin mono-therapy continuation does not result in more bleeding after knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-015-3824-0

    Google Scholar 

  10. Deutsche Gesellschaft für Rheumatologie (2013) dgrh.de/teraynaud0.html; dgrh.de/9472-76.html. Zugegriffen: 08.12.2016

  11. Lasocki S, Krauspe R, von Heymann C, Mezzacasa A, Chainey S, Spahn DR (2015) PREPARE: the prevalence of perioperative anaemia and need for patient blood management in elective orthopaedic surgery: a multicentre, observational study. Eur J Anaesthesiol 32(3):160–167. doi:10.1097/EJA.0000000000000202

    Article  PubMed  Google Scholar 

  12. Theusinger OM, Kind SL, Seifert B, Borgeat L, Gerber C, Spahn DR (2014) Patient blood management in orthopaedic surgery: a four-year follow-up of transfusion requirements and blood loss from 2008 to 2011 at the Balgrist University Hospital in Zurich, Switzerland. Blood Transfus 12(2):195–203. doi:10.2450/2014.0306-13

    PubMed  PubMed Central  Google Scholar 

  13. S3-Leitlinie zur Prophylaxe der venösen Thromboembolie (VTE). http://www.awmf.org/uploads/tx_szleitlinien/003-001l_S3_VTE-Prophylaxe_2015-12.pdf. Zugegriffen: 08.12.2016

  14. Hopkins PM (2015) Does regional anaesthesia improve outcome? Br J Anaesth 115(Suppl 2):26–33. doi:10.1093/bja/aev377

    Article  Google Scholar 

  15. Zywiel MG, Prabhu A, Perruccio AV, Gandhi R (2014) The influence of anesthesia and pain management on cognitive dysfunction after joint arthroplasty: a systematic review. Clin Orthop Relat Res 472(5):1453–1466. doi:10.1007/s11999-013-3363-2

    Article  PubMed  Google Scholar 

  16. Heidbuchel H, Verhamme P, Alings M, Antz M, Diener HC, Hacke W, Oldgren J, Sinnaeve P, Camm AJ, Kirchhof P, Advisors (2016) Updated European Heart Rhythm Association practical guide on the use of non-vitamin-K antagonist anticoagulants in patients with non-valvular atrial fibrillation: Executive summary. Eur Heart J. doi:10.1093/eurheartj/ehw058

    Google Scholar 

  17. Weber M, Völlner F, Benditz A et al. (2016) Kniegelenkersatz des älteren Menschen. Orthopäde. doi:10.1007/s00132-016-3363-5

  18. Waurick K (2014) Pitfalls of anesthesiologic management in operative or interventional securing of aneurysm. Anasthesiol Intensivmed Notfallmed Schmerzther 49(11–12):648–653. doi:10.1055/s-0040-100115

    PubMed  Google Scholar 

  19. Hadzic A, Minkowitz HS, Melson TI, Berkowitz R, Uskova A, Ringold F, Lookabaugh J, Ilfeld BM (2016) Liposome bupivacaine femoral nerve block for postsurgical analgesia after total knee arthroplasty. Anesthesiology 124(6):1372–1383. doi:10.1097/ALN.0000000000001117

    Article  CAS  PubMed  Google Scholar 

  20. Chan EY, Fransen M, Parker DA, Assam PN, Chua N (2014) Femoral nerve blocks for acute postoperative pain after knee replacement surgery. Cochrane Database Syst Rev 5:CD009941. doi:10.1002/14651858.CD009941.pub2

    Google Scholar 

  21. Jones CA, Voaklander DC, Johnston DW, Suarez-Almazor ME (2001) The effect of age on pain, function, and quality of life after total hip and knee arthroplasty. Arch Intern Med 161(3):454–460

    Article  CAS  PubMed  Google Scholar 

  22. Alentorn-Geli E, Leal-Blanquet J, Guirro P, Hinarejos P, Pelfort X, Puig-Verdié L (2013) Comparison of quality of life between elderly patients undergoing TKA. Orthopedics 36(4):e415–e419. doi:10.3928/01477447-20130327-15

    Article  PubMed  Google Scholar 

  23. Ravi B, Croxford R, Reichmann WM, Losina E, Katz JN, Hawker GA (2012) The changing demographics of total joint arthroplasty recipients in the United States and Ontario from 2001 to 2007. Best Pract Res Clin Rheumatol 26(5):637–647. doi:10.1016/j.berh.2012.07.014

    Article  PubMed  Google Scholar 

  24. Falbrede I, Widmer M, Kurtz S, Schneidmüller D, Dudda M, Röder C (2011) Utilization rates of lower extremity prostheses in Germany and Switzerland: a comparison of the years 2005–2008. Orthopäde 40(9):793–801. doi:10.1007/s00132-011-1787-5

    Article  CAS  PubMed  Google Scholar 

  25. Niethard FU, Deutsche Gesellschaft für Orthopädie und Orthopädische Chirurgie (2014) Versorgungsatlas. http://www.bdpk.de/media/file/1059.Forum_B_Dr._Niethard_LE_im_KH.pdf. Zugegriffen: 08.12.2016

  26. Kuperman EF, Schweizer M, Joy P, Gu X, Fang MM (2016) The effects of advanced age on primary total knee arthroplasty: a meta-analysis and systematic review. BMC Geriatr 16:41. doi:10.1186/s12877-016-0215-4

    Article  PubMed  PubMed Central  Google Scholar 

  27. Wright JG, Coyte P, Hawker G, Bombardier C, Cooke D, Heck D, Dittus R, Freund D (1995) Variation in orthopedic surgeons’ perceptions of the indications for and outcomes of knee replacement. CMAJ 152(5):687–697

    CAS  PubMed  PubMed Central  Google Scholar 

  28. Jasper LL, Jones CA, Mollins J, Pohar SL, Beaupre LA (2016) Risk factors for revision of total knee arthroplasty: a scoping review. Bmc Musculoskelet Disord 17(1):182. doi:10.1186/s12891-016-1025-8

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Namba RS, Cafri G, Khatod M, Inacio MC, Brox TW, Paxton EW (2013) Risk factors for total knee arthroplasty aseptic revision. J Arthroplasty 28(8 Suppl):122–127. doi:10.1016/j.arth.2013.04.050.

    Article  PubMed  Google Scholar 

  30. Jämsen E, Peltola M, Eskelinen A, Lehto MU (2013) Comorbid diseases as predictors of survival of primary total hip and knee replacements: a nationwide register-based study of 96 754 operations on patients with primary osteoarthritis. Ann Rheum Dis 72(12):1975–1982. doi:10.1136/annrheumdis-2012-202064

    Article  PubMed  Google Scholar 

  31. King KB, Findley TW, Williams AE, Bucknell AL (2013) Veterans with diabetes receive arthroplasty more frequently and at a younger age. Clin Orthop Relat Res 471(9):3049–3054. doi:10.1007/s11999-013-3026-3

    Article  PubMed  PubMed Central  Google Scholar 

  32. Bordini B, Stea S, Cremonini S, Viceconti M, De Palma R, Toni A (2009) Relationship between obesity and early failure of total knee prostheses. Bmc Musculoskelet Disord 10:29. doi:10.1186/1471-2474-10-29

    Article  PubMed  PubMed Central  Google Scholar 

  33. Haverkamp D, Klinkenbijl MN, Somford MP, Albers GH, van der Vis HM (2011) Obesity in total hip arthroplasty – does it really matter? A meta-analysis. Acta Orthop 82(4):417–422. doi:10.3109/17453674.2011.588859

    Article  PubMed  PubMed Central  Google Scholar 

  34. Liu W, Wahafu T, Cheng M, Cheng T, Zhang Y, Zhang X (2015) The influence of obesity on primary total hip arthroplasty outcomes: A meta-analysis of prospective cohort studies. Orthop Traumatol Surg Res 101(3):289–296. doi:10.1016/j.otsr.2015.01.011.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Orthopädische Klinik für die Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Deutschland

    C. Baier, J. Grifka, A. Keshmiri & G. Maderbacher

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  1. C. Baier
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  2. J. Grifka
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  3. A. Keshmiri
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  4. G. Maderbacher
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Correspondence to C. Baier.

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C. Baier, J. Grifka, A. Keshmiri und G. Maderbacher geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Baier, C., Grifka, J., Keshmiri, A. et al. Gelenkersatz des älteren Menschen. Orthopäde 46, 63–68 (2017). https://doi.org/10.1007/s00132-016-3367-1

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