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Erschienen in: Die Orthopädie 4/2020

23.01.2020 | Minimalinvasive Chirurgie | Leitthema

Fast-Track-Endoprothetik – intra- und postoperatives Management

verfasst von: Prof. Dr. M. Clarius, L. M. Clarius

Erschienen in: Die Orthopädie | Ausgabe 4/2020

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Zusammenfassung

Evidenzbasierte, interdisziplinäre Fast-Track-Behandlungskonzepte erlauben die schnellstmögliche und komplikationsarme Mobilisierung der Patienten nach Hüft- und Knieendoprothetik. Diese gelingt durch eine lokale Infiltrationsanästhesie im Rahmen eines multimodalen Schmerztherapiekonzeptes. Auf Blasenkatheter, Femoraliskatheter und Drainagen wird gänzlich verzichtet. Feste Bestandteile des intra- und postoperativen Managements sind die Gabe von Tranexamsäure zur Reduktion der Blutung und Transfusionshäufigkeit. Kortison wirkt analgetisch, antiemetisch und reduziert die postoperative Stressantwort. Minimalinvasive Operationstechniken und der Verzicht auf die Blutsperre ermöglichen ein besseres funktionelles Ergebnis und bewirken weniger Schmerzen. Verbote und Restriktionen sind nicht evidenzbasiert und daher verzichtbar.
Literatur
1.
Zurück zum Zitat Abdel-Salam A, Eyres KS (1995) Effects of tourniquet during total knee arthroplasty. A prospective randomised study. J Bone Joint Surg Br 77:250–253PubMed Abdel-Salam A, Eyres KS (1995) Effects of tourniquet during total knee arthroplasty. A prospective randomised study. J Bone Joint Surg Br 77:250–253PubMed
2.
Zurück zum Zitat Alvarez AP, Demzik AL, Alvi HM et al (2016) Risk factors for postoperative urinary tract infections in patients undergoing total joint arthroplasty. Adv Orthop 2016:7268985PubMedPubMedCentral Alvarez AP, Demzik AL, Alvi HM et al (2016) Risk factors for postoperative urinary tract infections in patients undergoing total joint arthroplasty. Adv Orthop 2016:7268985PubMedPubMedCentral
3.
Zurück zum Zitat Andersen LO, Husted H, Otte KS et al (2008) A compression bandage improves local infiltration analgesia in total knee arthroplasty. Acta Orthop 79:806–811PubMed Andersen LO, Husted H, Otte KS et al (2008) A compression bandage improves local infiltration analgesia in total knee arthroplasty. Acta Orthop 79:806–811PubMed
4.
Zurück zum Zitat Barnsley L, Barnsley L, Page R (2015) Are hip precautions necessary post total hip arthroplasty? A systematic review. Geriatr Orthop Surg Rehabil 6:230–235PubMedPubMedCentral Barnsley L, Barnsley L, Page R (2015) Are hip precautions necessary post total hip arthroplasty? A systematic review. Geriatr Orthop Surg Rehabil 6:230–235PubMedPubMedCentral
5.
Zurück zum Zitat Bjerke-Kroll BT, Sculco PK, Mclawhorn AS et al (2014) The increased total cost associated with post-operative drains in total hip and knee arthroplasty. J Arthroplasty 29:895–899PubMed Bjerke-Kroll BT, Sculco PK, Mclawhorn AS et al (2014) The increased total cost associated with post-operative drains in total hip and knee arthroplasty. J Arthroplasty 29:895–899PubMed
6.
Zurück zum Zitat Bjerregaard LS, Bagi P, Kehlet H (2014) Postoperative urinary retention (POUR) in fast-track total hip and knee arthroplasty. Acta Orthop 85:8–10PubMedPubMedCentral Bjerregaard LS, Bagi P, Kehlet H (2014) Postoperative urinary retention (POUR) in fast-track total hip and knee arthroplasty. Acta Orthop 85:8–10PubMedPubMedCentral
7.
Zurück zum Zitat Bjerregaard LS, Bogo S, Raaschou S et al (2015) Incidence of and risk factors for postoperative urinary retention in fast-track hip and knee arthroplasty. Acta Orthop 86:183–188PubMedPubMedCentral Bjerregaard LS, Bogo S, Raaschou S et al (2015) Incidence of and risk factors for postoperative urinary retention in fast-track hip and knee arthroplasty. Acta Orthop 86:183–188PubMedPubMedCentral
8.
Zurück zum Zitat Chaumeron A, Audy D, Drolet P et al (2013) Periarticular injection in knee arthroplasty improves quadriceps function. Clin Orthop Relat Res 471:2284–2295PubMedPubMedCentral Chaumeron A, Audy D, Drolet P et al (2013) Periarticular injection in knee arthroplasty improves quadriceps function. Clin Orthop Relat Res 471:2284–2295PubMedPubMedCentral
9.
Zurück zum Zitat De Oliveira GS Jr., Almeida MD, Benzon HT et al (2011) Perioperative single dose systemic dexamethasone for postoperative pain: a meta-analysis of randomized controlled trials. Anesthesiology 115:575–588PubMed De Oliveira GS Jr., Almeida MD, Benzon HT et al (2011) Perioperative single dose systemic dexamethasone for postoperative pain: a meta-analysis of randomized controlled trials. Anesthesiology 115:575–588PubMed
10.
Zurück zum Zitat Fukuda A, Hasegawa M, Kato K et al (2007) Effect of tourniquet application on deep vein thrombosis after total knee arthroplasty. Arch Orthop Trauma Surg 127:671–675PubMed Fukuda A, Hasegawa M, Kato K et al (2007) Effect of tourniquet application on deep vein thrombosis after total knee arthroplasty. Arch Orthop Trauma Surg 127:671–675PubMed
11.
Zurück zum Zitat Halawi MJ, Caminiti N, Cote MP et al (2019) The most significant risk factors for urinary retention in fast-track total joint arthroplasty are iatrogenic. J Arthroplasty 34:136–139PubMed Halawi MJ, Caminiti N, Cote MP et al (2019) The most significant risk factors for urinary retention in fast-track total joint arthroplasty are iatrogenic. J Arthroplasty 34:136–139PubMed
12.
Zurück zum Zitat Husted H, Gromov K, Malchau H et al (2014) Traditions and myths in hip and knee arthroplasty. Acta Orthop 85:548–555PubMedPubMedCentral Husted H, Gromov K, Malchau H et al (2014) Traditions and myths in hip and knee arthroplasty. Acta Orthop 85:548–555PubMedPubMedCentral
13.
Zurück zum Zitat Johnson RL, Kopp SL, Hebl JR et al (2013) Falls and major orthopaedic surgery with peripheral nerve blockade: a systematic review and meta-analysis. Br J Anaesth 110:518–528PubMedPubMedCentral Johnson RL, Kopp SL, Hebl JR et al (2013) Falls and major orthopaedic surgery with peripheral nerve blockade: a systematic review and meta-analysis. Br J Anaesth 110:518–528PubMedPubMedCentral
14.
Zurück zum Zitat Jorgensen CC, Jacobsen MK, Soeballe K et al (2013) Thromboprophylaxis only during hospitalisation in fast-track hip and knee arthroplasty, a prospective cohort study. BMJ Open 3:e3965PubMedPubMedCentral Jorgensen CC, Jacobsen MK, Soeballe K et al (2013) Thromboprophylaxis only during hospitalisation in fast-track hip and knee arthroplasty, a prospective cohort study. BMJ Open 3:e3965PubMedPubMedCentral
15.
Zurück zum Zitat Kandasami M, Kinninmonth AW, Sarungi M et al (2009) Femoral nerve block for total knee replacement—a word of caution. Knee 16:98–100PubMed Kandasami M, Kinninmonth AW, Sarungi M et al (2009) Femoral nerve block for total knee replacement—a word of caution. Knee 16:98–100PubMed
16.
Zurück zum Zitat Kehlet H (2013) Fast-track hip and knee arthroplasty. Lancet 381:1600–1602PubMed Kehlet H (2013) Fast-track hip and knee arthroplasty. Lancet 381:1600–1602PubMed
17.
Zurück zum Zitat Kehlet H, Dahl JB (2003) Anaesthesia, surgery, and challenges in postoperative recovery. Lancet 362:1921–1928PubMed Kehlet H, Dahl JB (2003) Anaesthesia, surgery, and challenges in postoperative recovery. Lancet 362:1921–1928PubMed
18.
Zurück zum Zitat Kehlet H, Thienpont E (2013) Fast-track knee arthroplasty—status and future challenges. Knee 20(1):29–33 Kehlet H, Thienpont E (2013) Fast-track knee arthroplasty—status and future challenges. Knee 20(1):29–33
19.
Zurück zum Zitat Kelly EG, Cashman JP, Imran FH et al (2014) Systematic review and meta-analysis of closed suction drainage versus non-drainage in primary hip arthroplasty. Surg Technol Int 24:295–301PubMed Kelly EG, Cashman JP, Imran FH et al (2014) Systematic review and meta-analysis of closed suction drainage versus non-drainage in primary hip arthroplasty. Surg Technol Int 24:295–301PubMed
20.
Zurück zum Zitat Khanna A, Gougoulias N, Longo UG et al (2009) Minimally invasive total knee arthroplasty: a systematic review. Orthop Clin North Am 40:479–489PubMed Khanna A, Gougoulias N, Longo UG et al (2009) Minimally invasive total knee arthroplasty: a systematic review. Orthop Clin North Am 40:479–489PubMed
21.
Zurück zum Zitat Kim TK, Chang CB, Koh IJ (2014) Practical issues for the use of tranexamic acid in total knee arthroplasty: a systematic review. Knee Surg Sports Traumatol Arthrosc 22:1849–1858PubMed Kim TK, Chang CB, Koh IJ (2014) Practical issues for the use of tranexamic acid in total knee arthroplasty: a systematic review. Knee Surg Sports Traumatol Arthrosc 22:1849–1858PubMed
22.
Zurück zum Zitat Ledin H, Aspenberg P, Good L (2012) Tourniquet use in total knee replacement does not improve fixation, but appears to reduce final range of motion. Acta Orthop 83:499–503PubMedPubMedCentral Ledin H, Aspenberg P, Good L (2012) Tourniquet use in total knee replacement does not improve fixation, but appears to reduce final range of motion. Acta Orthop 83:499–503PubMedPubMedCentral
23.
Zurück zum Zitat Li B, Wen Y, Wu H et al (2009) The effect of tourniquet use on hidden blood loss in total knee arthroplasty. Int Orthop 33:1263–1268PubMed Li B, Wen Y, Wu H et al (2009) The effect of tourniquet use on hidden blood loss in total knee arthroplasty. Int Orthop 33:1263–1268PubMed
24.
Zurück zum Zitat Liu D, Graham D, Gillies K et al (2014) Effects of tourniquet use on quadriceps function and pain in total knee arthroplasty. Knee Surg Relat Res 26:207–213PubMedPubMedCentral Liu D, Graham D, Gillies K et al (2014) Effects of tourniquet use on quadriceps function and pain in total knee arthroplasty. Knee Surg Relat Res 26:207–213PubMedPubMedCentral
25.
Zurück zum Zitat Loftus T, Agee C, Jaffe R et al (2014) A simplified pathway for total knee arthroplasty improves outcomes. J Knee Surg 27:221–228PubMed Loftus T, Agee C, Jaffe R et al (2014) A simplified pathway for total knee arthroplasty improves outcomes. J Knee Surg 27:221–228PubMed
26.
Zurück zum Zitat Lunn TH, Andersen LO, Kristensen BB et al (2013) Effect of high-dose preoperative methylprednisolone on recovery after total hip arthroplasty: a randomized, double-blind, placebo-controlled trial. Br J Anaesth 110:66–73PubMed Lunn TH, Andersen LO, Kristensen BB et al (2013) Effect of high-dose preoperative methylprednisolone on recovery after total hip arthroplasty: a randomized, double-blind, placebo-controlled trial. Br J Anaesth 110:66–73PubMed
27.
Zurück zum Zitat Madsen RV, Nielsen CS, Kallemose T et al (2017) Low risk of thromboembolic events after routine administration of tranexamic acid in hip and knee arthroplasty. J Arthroplasty 32:1298–1303PubMed Madsen RV, Nielsen CS, Kallemose T et al (2017) Low risk of thromboembolic events after routine administration of tranexamic acid in hip and knee arthroplasty. J Arthroplasty 32:1298–1303PubMed
28.
Zurück zum Zitat Nielsen CS, Jans O, Orsnes T et al (2016) Combined intra-articular and intravenous tranexamic acid reduces blood loss in total knee arthroplasty: a randomized, double-blind, placebo-controlled trial. J Bone Joint Surg Am 98:835–841PubMed Nielsen CS, Jans O, Orsnes T et al (2016) Combined intra-articular and intravenous tranexamic acid reduces blood loss in total knee arthroplasty: a randomized, double-blind, placebo-controlled trial. J Bone Joint Surg Am 98:835–841PubMed
29.
Zurück zum Zitat Noth U, Geiser T, Kranich T et al (2019) Fast track strategies in hip arthroplasty. Orthopäde 48:330–336PubMed Noth U, Geiser T, Kranich T et al (2019) Fast track strategies in hip arthroplasty. Orthopäde 48:330–336PubMed
30.
Zurück zum Zitat Panteli M, Papakostidis C, Dahabreh Z et al (2013) Topical tranexamic acid in total knee replacement: a systematic review and meta-analysis. Knee 20:300–309PubMed Panteli M, Papakostidis C, Dahabreh Z et al (2013) Topical tranexamic acid in total knee replacement: a systematic review and meta-analysis. Knee 20:300–309PubMed
31.
Zurück zum Zitat Parker MJ, Roberts CP, Hay D (2004) Closed suction drainage for hip and knee arthroplasty. A meta-analysis. J Bone Joint Surg Am 86:1146–1152PubMed Parker MJ, Roberts CP, Hay D (2004) Closed suction drainage for hip and knee arthroplasty. A meta-analysis. J Bone Joint Surg Am 86:1146–1152PubMed
32.
Zurück zum Zitat Parvataneni HK, Shah VP, Howard H et al (2007) Controlling pain after total hip and knee arthroplasty using a multimodal protocol with local periarticular injections: a prospective randomized study. J Arthroplasty 22:33–38PubMed Parvataneni HK, Shah VP, Howard H et al (2007) Controlling pain after total hip and knee arthroplasty using a multimodal protocol with local periarticular injections: a prospective randomized study. J Arthroplasty 22:33–38PubMed
33.
Zurück zum Zitat Petersen PB, Kehlet H, Jorgensen CC (2018) Safety of in-hospital only thromboprophylaxis after fast-track total hip and knee arthroplasty: a prospective follow-up study in 17,582 procedures. Thromb Haemost 118:2152–2161PubMed Petersen PB, Kehlet H, Jorgensen CC (2018) Safety of in-hospital only thromboprophylaxis after fast-track total hip and knee arthroplasty: a prospective follow-up study in 17,582 procedures. Thromb Haemost 118:2152–2161PubMed
34.
Zurück zum Zitat Shang J, Wang H, Zheng B et al (2016) Combined intravenous and topical tranexamic acid versus intravenous use alone in primary total knee and hip arthroplasty: a meta-analysis of randomized controlled trials. Int J Surg 36:324–329PubMed Shang J, Wang H, Zheng B et al (2016) Combined intravenous and topical tranexamic acid versus intravenous use alone in primary total knee and hip arthroplasty: a meta-analysis of randomized controlled trials. Int J Surg 36:324–329PubMed
35.
Zurück zum Zitat Smith TO, Hing CB (2010) Is a tourniquet beneficial in total knee replacement surgery? A meta-analysis and systematic review. Knee 17:141–147PubMed Smith TO, Hing CB (2010) Is a tourniquet beneficial in total knee replacement surgery? A meta-analysis and systematic review. Knee 17:141–147PubMed
36.
Zurück zum Zitat Smith TO, Jepson P, Beswick A et al (2016) Assistive devices, hip precautions, environmental modifications and training to prevent dislocation and improve function after hip arthroplasty. Cochrane Database Syst Rev 7:Cd10815PubMed Smith TO, Jepson P, Beswick A et al (2016) Assistive devices, hip precautions, environmental modifications and training to prevent dislocation and improve function after hip arthroplasty. Cochrane Database Syst Rev 7:Cd10815PubMed
37.
Zurück zum Zitat Spangehl MJ, Clarke HD, Hentz JG et al (2015) The Chitranjan Ranawat award: periarticular injections and femoral & sciatic blocks provide similar pain relief after TKA: a randomized clinical trial. Clin Orthop Relat Res 473:45–53PubMed Spangehl MJ, Clarke HD, Hentz JG et al (2015) The Chitranjan Ranawat award: periarticular injections and femoral & sciatic blocks provide similar pain relief after TKA: a randomized clinical trial. Clin Orthop Relat Res 473:45–53PubMed
38.
Zurück zum Zitat Tai TW, Chang CW, Lai KA et al (2012) Effects of tourniquet use on blood loss and soft-tissue damage in total knee arthroplasty: a randomized controlled trial. J Bone Joint Surg Am 94:2209–2215PubMed Tai TW, Chang CW, Lai KA et al (2012) Effects of tourniquet use on blood loss and soft-tissue damage in total knee arthroplasty: a randomized controlled trial. J Bone Joint Surg Am 94:2209–2215PubMed
39.
Zurück zum Zitat Toftdahl K, Nikolajsen L, Haraldsted V et al (2007) Comparison of peri- and intraarticular analgesia with femoral nerve block after total knee arthroplasty: a randomized clinical trial. Acta Orthop 78:172–179PubMed Toftdahl K, Nikolajsen L, Haraldsted V et al (2007) Comparison of peri- and intraarticular analgesia with femoral nerve block after total knee arthroplasty: a randomized clinical trial. Acta Orthop 78:172–179PubMed
40.
Zurück zum Zitat van der Weegen W, Kornuijt A, Das D (2016) Do lifestyle restrictions and precautions prevent dislocation after total hip arthroplasty? A systematic review and meta-analysis of the literature. Clin Rehabil 30:329–339PubMed van der Weegen W, Kornuijt A, Das D (2016) Do lifestyle restrictions and precautions prevent dislocation after total hip arthroplasty? A systematic review and meta-analysis of the literature. Clin Rehabil 30:329–339PubMed
41.
Zurück zum Zitat Vandenbussche E, Duranthon LD, Couturier M et al (2002) The effect of tourniquet use in total knee arthroplasty. Int Orthop 26:306–309PubMedPubMedCentral Vandenbussche E, Duranthon LD, Couturier M et al (2002) The effect of tourniquet use in total knee arthroplasty. Int Orthop 26:306–309PubMedPubMedCentral
42.
Zurück zum Zitat Wakankar HM, Nicholl JE, Koka R et al (1999) The tourniquet in total knee arthroplasty. A prospective, randomised study. J Bone Joint Surg Br 81:30–33PubMed Wakankar HM, Nicholl JE, Koka R et al (1999) The tourniquet in total knee arthroplasty. A prospective, randomised study. J Bone Joint Surg Br 81:30–33PubMed
43.
Zurück zum Zitat Wauke K, Nagashima M, Kato N et al (2002) Comparative study between thromboembolism and total knee arthroplasty with or without tourniquet in rheumatoid arthritis patients. Arch Orthop Trauma Surg 122:442–446PubMed Wauke K, Nagashima M, Kato N et al (2002) Comparative study between thromboembolism and total knee arthroplasty with or without tourniquet in rheumatoid arthritis patients. Arch Orthop Trauma Surg 122:442–446PubMed
44.
Zurück zum Zitat Yun XD, Yin XL, Jiang J et al (2015) Local infiltration analgesia versus femoral nerve block in total knee arthroplasty: a meta-analysis. Orthop Traumatol Surg Res 101:565–569PubMed Yun XD, Yin XL, Jiang J et al (2015) Local infiltration analgesia versus femoral nerve block in total knee arthroplasty: a meta-analysis. Orthop Traumatol Surg Res 101:565–569PubMed
Metadaten
Titel
Fast-Track-Endoprothetik – intra- und postoperatives Management
verfasst von
Prof. Dr. M. Clarius
L. M. Clarius
Publikationsdatum
23.01.2020
Verlag
Springer Medizin
Erschienen in
Die Orthopädie / Ausgabe 4/2020
Print ISSN: 2731-7145
Elektronische ISSN: 2731-7153
DOI
https://doi.org/10.1007/s00132-020-03867-y

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