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Erschienen in: Der Orthopäde 4/2014

01.04.2014 | Leitthema

Endoprothetische Versorgung bei osteoporoseassoziierter Koxarthrose

Aspekte zur sicheren Patientenversorgung

verfasst von: PD Dr. S. Kirschner, MBA, A. Hartmann, K.-P. Günther, C. Hamann

Erschienen in: Die Orthopädie | Ausgabe 4/2014

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Zusammenfassung

Hintergrund

Mit steigender Lebenserwartung steigt auch die Prävalenz der Arthrose relevant an. Der typische Patient mit operationsbedürftiger Osteoarthrose zwischen 65 und 75 Lebensjahren weist zu 20–25 % eine bisher unerkannte Osteoporose auf.

Fragestellung

Welcher Ablauf bietet sich für die Abklärung einer eventuellen Osteoporose präoperativ an? Welche Schlussfolgerungen werden für die operative Versorgung und die Nachbehandlung daraus gezogen?

Material und Methode

Die zur Verfügung stehende Literatur zur Erkrankungsprävalenz der Osteoporose, perioperativen Komplikationen bei Hüftendoprothesen, ausgewählte Registerinformationen, die Leitlinie zur Diagnostik und Therapie der Osteoporose sowie die einer angemessenen Nachbehandlung wurden in der vorliegenden Übersichtsarbeit zusammengefasst.

Ergebnisse

Die orthopädisch-osteologische Abklärung ermittelt das Frakturrisiko nach Hinweisen des DVO (Dachverband Osteologie) und der Beckenübersichtsaufnahme. Basierend auf der Risikoeinschätzung wird eine Empfehlung zur Implantatwahl und Verankerung gegeben. Wesentliche Risiken der operativen Versorgung einer Koxarthrose bei Osteoporose sind die intraoperative Fraktur und die kurzfristige aseptische Lockerung. In der Nachbehandlung sind ergänzend zur Endoprothesenschule eine suffiziente Sturzprophylaxe und dauerhafte Übungsbehandlung wichtig. Die Dauermedikation sollte auf Risikopräparate der PRISCUS-Liste überprüft werden. Das besondere kardiale Risikoprofil der NSAR (nichtsteroidale Antirheumatika) sollte berücksichtigt und für Patienten mit nachgewiesener Osteoporose eine antiresorptive Therapie eingeleitet werden.
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Metadaten
Titel
Endoprothetische Versorgung bei osteoporoseassoziierter Koxarthrose
Aspekte zur sicheren Patientenversorgung
verfasst von
PD Dr. S. Kirschner, MBA
A. Hartmann
K.-P. Günther
C. Hamann
Publikationsdatum
01.04.2014
Verlag
Springer Berlin Heidelberg
Erschienen in
Die Orthopädie / Ausgabe 4/2014
Print ISSN: 2731-7145
Elektronische ISSN: 2731-7153
DOI
https://doi.org/10.1007/s00132-013-2167-0

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