Skip to main content

Patientenoptimierung für einen Hüft-TEP-Wechsel

Umgang mit Komorbiditäten

Patient optimization before hip revision arthroplasty:

How to handle comorbidities

Zusammenfassung

Eine Optimierung der Behandlung von Komorbiditäten vor endoprothetischen Wechseleingriffen am Hüftgelenk hat das Potenzial für eine Verbesserung der Ergebnisse und eine Reduzierung der Kosten für das Gesundheitssystem. Nichtimplantatbezogene Einflussfaktoren, wie z. B. Adipositas, führen mit steigender Inzidenz zu einer deutlichen Erhöhung der Ausfallwahrscheinlichkeit. Wichtige und potenziell beeinflussbare Komorbiditäten sind hierbei die präoperative Anämie, Koagulopathien, infektiologische Erkrankungen (sanierungsbedürftiger Zahnstatus, Harnwegsinfekte, Besiedelung mit Staphylokokken), Stoffwechselerkrankungen (Adipositas, Malnutrition, Diabetes mellitus, Osteoporose) und Nikotinabusus. Zur zielführenden Optimierung bedarf es in der Regel eines interdisziplinären Therapieansatzes, um den maximalen Erfolg zu generieren.

Abstract

Preoperative optimization of the therapeutic regime of comorbidities can lead to an improvement of the postoperative outcome and has the potential to reduce the financial burden on the health care system in revision hip arthroplasty. Patient-related factors and an increasing incidence of comorbidities lead to a higher risk of implant failure and revision for all causes. Important and potentially modifiable risk factors like preoperative anemia, coagulopathy, infectious disease (dental status, urinary tract infections, colonization with staphylococcus), metabolic conditions (obesity, malnutrition, diabetes mellitus, osteoporosis), and smoking need to be addressed. To achieve an optimal preoperative condition a multidisciplinary approach should be applied.

This is a preview of subscription content, access via your institution.

Abb. 1
Abb. 2

Abbreviations

BMI:

Body-Mass-Index

DGAI :

Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin

DGOU :

Deutsche Gesellschaft für Orthopädie und Unfallchirurgie

DVO :

Dachverband für Osteologie

EFORT :

European Federation of National Associations of Orthopaedics and Traumatology.

EPRD :

Endoprothesenregister Deutschland

MRSA :

Methicillin-resistenter Staphylococcus aureus

TEP :

Totalendoprothese

WHO :

World Health Organization

Literatur

  1. Labek G, Thaler M, Janda W, Agreiter M, Stöckl B (2011) Revision rates after total joint replacement: cumulative results from worldwide joint register datasets. J Bone Joint Surg Br 93:293–297. https://doi.org/10.1302/0301-620X.93B3.25467

    CAS  Article  PubMed  Google Scholar 

  2. Schwartz AM, Farley KX, Guild GN, Bradbury TL Jr (2020) Projections and epidemiology of revision hip and knee arthroplasty in the United States to 2030. J Arthroplasty 35:79–85. https://doi.org/10.1016/j.arth.2020.02.030

    Article  Google Scholar 

  3. Siddiqi A, Warren JA, Manrique-Succar J, Molloy R, Barsoum WK, Piuzzi NS (2021) Temporal trends in revision total hip and knee arthroplasty from 2008 to 2018: gaps and opportunities. J Bone Joint Surg Am 1093:1335–1354. https://doi.org/10.2106/JBJS.20.01184

    Article  Google Scholar 

  4. Grimberg A, Jansson V, Lützner J, Melsheimer O, Morlock M, Steinbrück A (2021) Jahresbericht 2021. Endoprothesenregister Deutschland (EPRD) https://doi.org/10.36186/reporteprd042021

    Book  Google Scholar 

  5. Günther KP, Deckert S, Lützner C, Lange T, Schmitt J, Postler A (2021) Hüfttotalendoprothese bei Coxarthrose – evidezbasierte und patientenorientierte Indikationsstellung. Dtsch Arztebl Int 118:737–738. https://doi.org/10.3238/aerztebl.m2021.0272

    Article  Google Scholar 

  6. Gómez-Ramirez S, Jericó C, Munoz M (2019) Perioperative anemia: prevalence, consequences and pathophysiology. Transfus Apher Sci 58:369–374. https://doi.org/10.1016/j.transci.2019.06.011

    Article  PubMed  Google Scholar 

  7. Gu A, Chen AZ, Selemon NA, Tornberg H, Wei C, Fassihi SC, Campbell JC, Sculco PK (2021) Preoperative anemia independently predicts significantly increased odds of short-term complications following aseptic revision hip and knee arthroplasty. J Arthroplasty 36:1719–1728. https://doi.org/10.1016/j.arth.2020.10.061

    Article  PubMed  Google Scholar 

  8. Lu M, Sing DC, Kuo AC, Hansen EN (2017) Preoperative anemia independently predicts 30-day complications after aseptic and septic revision total joint arthroplasty. J Arthroplasty 32:197–201. https://doi.org/10.1016/j.arth.2017.02.076

    Article  Google Scholar 

  9. Sershon RA, Fillingham YA, Malkani AL, Abdel MP, Schwarzkopf R, Padgett DE, Vail TP, Della Valle CJ, Hip Society Research Group (2021) Independent risk factors for transfusion in contemporary revision total hip arthroplasty. J Arthroplasty 36:2921–2926. https://doi.org/10.1016/j.arth.2021.03.032

    Article  PubMed  Google Scholar 

  10. Kaufner L, von Heymann C (2018) S3 Leitlinie Diagnostik und Therapie der Präoperativen Anämie. https://www.awmf.org/uploads/tx_szleitlinien/001-024l_S3_Praeoperative-Anaemie_2018-04-verlaengert.pdf. Zugegriffen: 27. März 2022

  11. Dinesh PA, Frew N (2017) Preoperative optimisation of anemia for primary total hip arthroplasty: a systematic review. Hip Int 27:512–522. https://doi.org/10.5301/hipint.5000530

    Article  Google Scholar 

  12. Chung JJ, Dolan MT, Patetta MJ, DesLaurier JT, Boroda N, Gonzalez MH (2021) Abnormal coagulation as a risk factor for postoperative complications after primary and revision total hip and total knee arthroplasty. J Arthroplasty 36:3294–3299. https://doi.org/10.1016/j.arth.2021.04.024

    Article  PubMed  Google Scholar 

  13. Chiasakul T, Buckner TW, Li M, Vega R, Gimotty PA, Cuker A (2020) In-hospital complications and readmission in patients with hemophilia undergoing hip or knee arthroplasty. JBJS Open Access 5(2):e85. https://doi.org/10.2106/JBJS.OA.19.00085

    Article  PubMed  PubMed Central  Google Scholar 

  14. Kocaoglu H, Hennes F, Abdelaziz H, Sandiford NA, Gehrke T, Citak M (2020) Do patients with von Willebrand disease exhibit higher blood loss and revision rates in hip and knee arthroplasty? A case-control study. Haemophilia 26:513–519. https://doi.org/10.1111/hae.13962

    Article  PubMed  Google Scholar 

  15. Yaghmour KM, Peng Y, Chisari E, Khan W, McDonnell SM (2018) Management of von Willebrand diseases in patients undergoing total hip and knee arthroplasty. J Perioper Pract 29:266–269. https://doi.org/10.1177/1750458918820793

    Article  Google Scholar 

  16. Wang C, Kang P, Ma J, Yue C, Xie J, Pei F (2016) Single-dose tranexamic acid for reducing bleeding and transfusions in total hip arthroplasty: a double-blind, randomized controlled trial of different doses. Thromb Res 141:119–123. https://doi.org/10.1016/j.thromres.2016.02.027

    CAS  Article  PubMed  Google Scholar 

  17. Poeran J, Chan JJ, Zubizarreta N, Mazumdar M, Galatz LM, Moucha CS (2021) Safety of tranexamic acid in hip and knee arthroplasty in high-risk patients. Anesthesiology 135:57–68. https://doi.org/10.1097/ALN0000000000003772

    CAS  Article  PubMed  Google Scholar 

  18. Devereaux PJ, Marcucci M, Painter TW, Conen D, Lomivorotov V, Sessler DI, Chan MTV, Borges FK, Martínez-Zapata MJ, Wang CY, Xavier D, Ofori SN, Wang MK, Efremov S, Landoni G, Kleinlugtenbelt YV, Szczeklik W, Schmartz D, Garg AX, Short TG, Wittmann M, Meyhoff CS, Amir M, Torres D, Patel A, Duceppe E, Ruetzler K, Parlow JL, Tandon V, Fleischmann E, Polanczyk CA, Lamy A, Astrakov SV, Rao M, Wu WKK, Bhatt K, de Nadal M, Likvantsev VV, Paniagua P, Aguado HJ, Whitlock RP, McGillion MH, Prystajecky M, Vincent J, Eikelboom J, Copland I, Balasubramanian K, Turan A, Bangdiwala SI, Stillo D, Gross PL, Cafaro T, Alfonsi P, Roshanov PS, Belley-Côte EP, Spence J, Richards T, VanHelder T, McIntyre W, Guyatt G, Yusuf S, Leslie K, POISE‑3 Investigators (2022) Tranexamic acid in patients undergoing noncardiac surgery. N Eng J Med. https://doi.org/10.1056/NEJMoa2201171

    Article  Google Scholar 

  19. Allegranzi B, Bischoff P, Kubilay Z, de Jonge S, Zayed B, Abbas M, Damani N, Hipman J, Sudan R, Allen T, Carnica Carreno JL, Norris S (2018) Global guidelines for the prevention of surgical site infection, 2. Aufl. World Health Organization, Genf

    Google Scholar 

  20. Heller K‑D, Perka C, Renz N (2022) Handlungsempfehlung für die Antibiotikaprophylaxe bei zahnmedizinischen Eingriffen – ein Update. https://www.ae-germany.com/images/ae/oeffentlich/pdf-handlungsanweisungen/Handlungsempfehlung_AB_Prophylaxe_Update_Januar_2022.pdf. Zugegriffen: 12. Apr. 2022 (AE Handlungsempfehlung. Deutsche Gesellschaft für Endoprothetik e. V.)

  21. Slullitel PA, Onativia JI, Piuzzi NS, Higuera-Rueda C, Parvizi J, Buttaro MA (2020) Is there a role for antibiotic prophylaxis prior to dental procedures in patients with total joint arthroplasty? A systematic review of the literature. J Bone Jt Infect 5:7–15. https://doi.org/10.7150/jbjj.40096

    Article  PubMed  PubMed Central  Google Scholar 

  22. Tokarski AT, Patel RG, Parvizi J, Deirmengian GK (2014) Dental clearance prior to elective arthroplasty may not be needed for everyone. J Arthroplasty 29:1729–1732. https://doi.org/10.1016/j.arth.2014.04.018

    Article  PubMed  Google Scholar 

  23. Lampley A, Huang RC, Arnold WV, Parvizi J (2014) Total joint arthroplasty: should patients have preoperative dental clearance? J Arthroplasty 29:1087–1090. https://doi.org/10.1016/j.arth.2013.11.019

    Article  PubMed  Google Scholar 

  24. Sousa RJ, Abreu MA, Wouthuyzen-Bakker M, Soriano AV (2019) Is routine urinary screening indicated prior to elective total joint arthroplasty? A systematic review and meta-analysis. J Arthroplasty 34:1523–1530. https://doi.org/10.1016/j.arth.2019.03.034

    Article  PubMed  Google Scholar 

  25. Wagenlehner F, Schmiemann G (2017) Interdisziplinäre S3-Leitlinie Epidemiologie, Diagnostik, Therapie, Prävention und Management unkomplizierter, bakterieller, ambulant erworbener Harnwegsinfektionen bei erwachsenen Patienten Aktualisierung 2017. https://www.awmf.org/uploads/tx_szleitlinien/043-044I_S3_Harnwegsinfektionen.pdf. Zugegriffen: 12. Apr. 2022 (AWMF Registernummer: 043/044)

  26. Tonotsuka H, Sugiyama H, Amagami A, Yonemoto K, Sato R, Saito M (2021) What is the most cost-effektive strategy for nasal screening and staphylococcus aureus decolonization in patients undergoing total hip arthroplasty? BMC Musculoskelet Disord 22:129. https://doi.org/10.1186/s12891-021-04008

    Article  PubMed  PubMed Central  Google Scholar 

  27. Zhu X, Sun X, Zeng Y, Feng W, Li J, Zeng J, Zeng Y (2020) Can nasal Staphylococcus aureus screening and decolonization prior to elective total joint arthroplasty reduce surgical site and prosthesis-related infections? A systematic review and meta-analysis. J Orthop Surg Res 15:60. https://doi.org/10.1186/s13018-020-01601-0

    Article  PubMed  PubMed Central  Google Scholar 

  28. Rohrer F, Wendt M, Noetzli H, Risch L, Bodmer T, Cottagnoud P, Hermann T, Limacher A, Gahl B, Bruegger J (2021) Preoperative decolonization and periprosthetic joint infections—a randomized controlled trial with 2‑year follow-up. J Orthop Res 39:333–338. https://doi.org/10.1002/jor.24916

    CAS  Article  PubMed  Google Scholar 

  29. Kapdia BH, Jauregui JJ, Murray DP, Mont MA (2016) Does preadmission cutaneous chlorhexidine preparation reduce surgical site infections after total hip arthroplasty? Clin Orthop Relat Res 474:1583–1588. https://doi.org/10.1007/s11999-016-4748-9

    Article  Google Scholar 

  30. Robert Koch Institut (2012) Studie zur Gesundheit Erwachsener in Deutschland (DEGS1). https://www.rki.de/DE/Content/Gesundheitsmonitoring/Studien/Degs/degs_w1/degs_w1_node.html;jsessionid=571104CFE7E767BDF6A322AA057DB994.internet081. Zugegriffen: 12. Apr. 2022

  31. Reyes C, Leyland KM, Peat G, Cooper C, Arden NK, Prieto-Alhambra D (2016) Association between overweight and obesity and risk of clinically diagnosed knee, hip, and hand osteoarthritis: a population-based cohort study. Arthritis Rheumatol 68:1869–1875. https://doi.org/10.1002/art.39707

    Article  PubMed  PubMed Central  Google Scholar 

  32. Ahmad SS, Orlik L, Ahmad SJS, Albers CE, Siebenrock KA, Klenke FM (2019) Obesity and smoking predict the results of two-stage exchange in septic revision hip arthroplasty: a cohort study. Orthop Traumatol Surg Res 105:467–471. https://doi.org/10.1016/j.otsr.2019.01.006

    Article  PubMed  Google Scholar 

  33. George H, Klika AK, Navale SM, Newmann JM, Barsoum WK, Higuera CA (2017) Obesity epidemic: is its impact on total joint arthroplasty underestimated? An analysis of national trends. Clin Orthop Relat Res 475:1798–1806. https://doi.org/10.1007/s11999-016-5222-4

    Article  PubMed  PubMed Central  Google Scholar 

  34. Ward DT, Metz LN, Horst PK, Kim HT, Kuo AC (2015) Complications of morbid obesity in total joint arthroplasty: risk stratification based on BMI. J Arthroplasty 30:42–46. https://doi.org/10.1016/j.arth.2015.03.045

    Article  PubMed  Google Scholar 

  35. Li S, Luo X, Sun H, Wang K, Zhang K, Sun X (2019) Does prior bariatric surgery improve outcomes following total joint arthroplasty in the morbidly obese? A meta-analysis. J Arthroplasty 34:577–585. https://doi.org/10.1016/j.arth.2018.11.018

    Article  PubMed  Google Scholar 

  36. Fu MC, D’Ambrosia C, McLawhorn AS, Schairer WW, Padgett DE, Cross MB (2016) Malnutrition increases with obesity and is a stronger independent risk factor for postoperative complications: a propensity-adjusted analysis of total hip arthroplasty patients. J Arthroplasty 31:2415–2421. https://doi.org/10.1016/j.arth.2016.04.032

    Article  PubMed  Google Scholar 

  37. Maimaiti Z, Xu C, Fu J, Li WT, Chai W, Zhou Y, Chen J (2021) A novel biomarker to screen for malnutrition: albumin/fibrinogen ration predicts septic failure and acute infection in patients who underwent revision total joint arthroplasty. J Arthroplasty 36:3282–3288. https://doi.org/10.1016/j.arth.2021.04.027

    Article  PubMed  Google Scholar 

  38. Weimann A, Breitenstein S, Breuer JP, Gabor SE, Holland-Cunz S, Kemen M, Längle F, Rayes N, Reith B, Rittler P, Schwenk W, Senkal M, DGEM Steering Committee (2013) S3-Leitlinie der Deutschen Gesellschaft für Ernährungsmedizin (DGEM) in Zusammenarbeit mit der GESKES, der AKE, der DGCH, der DGAI und der DGAV Klinische Ernährung in der Chirurgie. Aktuel Ernahrungsmed 38:e155–197. https://doi.org/10.1055/s-0033-1359887

    Article  Google Scholar 

  39. Rahman TM, Fleifel D, Padela MT, Anoushiravani A, Rizvi SA, El-Othmani MM, Sayeed Z (2020) Interventions for obesity and nutritional status in arthroplasty patients. JBJS Rev. https://doi.org/10.2106/JBJS.RVW.19.00161

    Article  PubMed  Google Scholar 

  40. López-de-Andrés A, Hernández-Barrera V, Martínez-Huedo MA, Villanueva-Martinez M, Jiménez-Trujillo I, Jiménez-García R (2017) Type 2 diabetes and in-hospital complications after revision of total hip and knee arthroplasty. PLoS ONE 12:e183796. https://doi.org/10.1371/jorunal.pone.0183796

    Article  PubMed  PubMed Central  Google Scholar 

  41. Wu LM, Si HB, Li MY, Wu YG, Zeng Y, Shen B (2021) Insulin dependence increases the risk of complications and death in total joint arthroplasty: a systematic review and meta-(regression) analysis. Orthop Surg 13:719–733. https://doi.org/10.1111/os.12944

    Article  PubMed  PubMed Central  Google Scholar 

  42. Shohat N, Tarabichi M, Tischler EH, Jabbour S, Parvizi J (2017) Serum fructosamine: a simple and inexpensive test for assessing preoperative glycemic control. J Bone Joint Surg Am 99:1900–1907. https://doi.org/10.2106/JBJS.17.00075

    Article  PubMed  Google Scholar 

  43. Ribeiro RT, Macedo MP, Raposo JF (2016) HbA1c, fructosamine, and glycated albumin in the detection of dysglycaemic conditions. Curr Diabetes Rev 12:14–19. https://doi.org/10.2174/1573399811666150701143112

    CAS  Article  PubMed  Google Scholar 

  44. Delsmann MM, Strahl A, Mühlenfeld M, Jandl NM, Beil FT, Ries C, Rolvien T (2021) High prevalence and undertreatment of osteoporosis in elderly patients undergoing total hip arthroplasty. Osteoporos Int 32:1661–1668. https://doi.org/10.1007/s00198-021-05881-y

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  45. Klemt C, Chen W, Bounajem G, Tirumala V, Xiong L, Kwon YM (2021) Outcome and risk factors of failures associated with revision total hip arthroplasty for recurrent dislocation. Arch Orthop Trauma Surg. https://doi.org/10.1007/s00402-021-03814-2

    Article  PubMed  Google Scholar 

  46. DVO Leitlinie Osteoporose (2017) Kitteltaschenversion. https://dv-osteologie.org/uploads/Leitlinie%202017/DVO%20Leitlinie_Kitteltaschenversion_gesamt.pdf. Zugegriffen: 1. Apr. 2022

  47. Bedard NA, Dowdle SB, Owens HM, Duchman KR, Gao Y, Callaghan JJ (2018) What is the impact of smoking on revision total hip arthroplasty? J Arthroplasty 33:183–185. https://doi.org/10.1016/j.arth.2017.12.041

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Max Jaenisch.

Ethics declarations

Interessenkonflikt

M. Jaenisch und D.C. Wirtz geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

Additional information

figure qr

QR-Code scannen & Beitrag online lesen

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Jaenisch, M., Wirtz, D.C. Patientenoptimierung für einen Hüft-TEP-Wechsel. Orthopädie 51, 619–630 (2022). https://doi.org/10.1007/s00132-022-04273-2

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00132-022-04273-2

Schlüsselwörter

  • Anämie
  • Mangelernährung
  • Revisionschirurgie
  • Risikofaktoren
  • Totaler Hüftersatz

Keywords

  • Anemia
  • Malnutrition
  • Revision surgery
  • Risk factors
  • Total hip replacement