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Besonderheiten beim elektiven Hüftgelenkersatz des älteren Menschen

Characteristics of elective hip replacement in the elderly

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Zusammenfassung

Aufgrund des demografischen Wandels wird eine zunehmend größere Anzahl von Patienten im fortgeschrittenen Lebensalter mit einer Hüfttotalendoprothese versorgt. Um eine sichere Versorgung des älteren Patienten zu gewährleisten, müssen die mit dem Alter verbundenen Besonderheiten beachtet werden. Diese werden in der vorliegenden Übersichtsarbeit dargestellt. Zudem wurden die altersabhängigen Versorgungsstrategien und Komplikationsraten des eigenen Patientenguts aus den Jahren 2010 bis 2015 ausgewertet. Von insgesamt 3166 Patienten waren 439 über 80 Jahre alt (Durchschnittsalter 84 Jahre). Die Daten der wissenschaftlichen Literatur sowie die eigenen Ergebnissen zeigen, dass der elektive Hüftgelenkersatz des älteren Patienten ein operationstechnisch sicheres Verfahren darstellt. Das patientenspezifische Risikoprofil muss jedoch individuell betrachtet werden, um im Falle relativ geringer Anzeichen einer sich abzeichnenden Komplikation gegenzusteuern.

Abstract

Due to demographic changes the number of elderly patients undergoing hip replacement surgery is increasing. In order to ensure safe treatment of elderly patients, age-specific medical factors must be taken into consideration. This article presents an overview of these factors. Furthermore, we evaluated our own patients treated between 2010 and 2015 regarding age-related treatment strategies and complication rates. Out of 3166 patients a total of 439 were over 80 years old (average age 84 years). It can be concluded from the scientific literature and from own data that elective hip replacement surgery in elderly patients is a technically safe procedure; however, the risk profile of each patient must be thoroughly analyzed so that in the event of even minor signs of potential complications countermeasures can be taken in good time.

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Literatur

  1. Learmonth ID, Young C, Rorabeck C (2007) The operation of the century: total hip replacement. Lancet 370(9597):1508–1519

    Article  PubMed  Google Scholar 

  2. Thienpont E, Vanden Berghe A, Schwab PE, Forthomme JP, Cornu O (2016) Joint awareness in osteoarthritis of the hip and knee evaluated with the ‘Forgotten Joint’ Score before and after joint replacement. Knee Surg Sports Traumatol Arthrosc 24:3346. doi:10.1007/s00167-015-3970-4

    Article  CAS  PubMed  Google Scholar 

  3. Wengler A, Nimptsch U, Mansky T (2014) Hip and knee replacement in Germany and the USA – analysis of individual inpatient data from German and US hospitals for the years 2005 to 2011. Dtsch Arztebl Int 111:407–416

    PubMed  PubMed Central  Google Scholar 

  4. Dagenais S, Garbedian S, Wai EK (2009) Systematic review of the prevalence of radiographic primary hip osteoarthritis. Clin Orthop Relat Res 467(3):623–637

    Article  PubMed  Google Scholar 

  5. Palmer KT, Goodson N (2015) Ageing, musculoskeletal health and work. Best Pract Res Clin Rheumatol 29(3):391–404

    Article  PubMed  PubMed Central  Google Scholar 

  6. Chan MY, Center JR, Eisman JA, Nguyen TV (2014) Bone mineral density and association of osteoarthritis with fracture risk. Osteoarthr Cartil 22(9):1251–1258

    Article  CAS  PubMed  Google Scholar 

  7. Skinner D, Tadros BJ, Bray E, Elsherbiny M, Stafford G (2016) Clinical outcome following primary total hip or knee replacement in nonagenarians. Ann R Coll Surg Engl 98(4):258–264

    Article  CAS  PubMed  Google Scholar 

  8. Yuasa T, Maezawa K, Nozawa M, Kaneko K (2016) Cementless total hip arthroplasty in patients aged ≥80 years. J Orthop 13(1):29–32

    Article  PubMed  Google Scholar 

  9. Adeli B, Parvizi J (2012) Strategies for the prevention of periprosthetic joint infection. J Bone Joint Surg Br 94(11 Suppl A):42–46

    Article  CAS  PubMed  Google Scholar 

  10. Chen J, Cui Y, Li X, Miao X, Wen Z, Xue Y, Tian J (2013) Risk factors for deep infection after total knee arthroplasty: a meta-analysis. Arch Orthop Trauma Surg 133(5):675–687

    Article  PubMed  Google Scholar 

  11. Chrastil J, Anderson MB, Stevens V, Anand R, Peters CL, Pelt CE (2015) Is hemoglobin A1c or perioperative hyperglycemia predictive of periprosthetic joint infection or death following primary total joint arthroplasty? J Arthroplasty 30(7):1197–1120

    Article  PubMed  Google Scholar 

  12. Maradit Kremers H, Lewallen LW, Mabry TM, Berry DJ, Berbari EF, Osmon DR (2015) Diabetes mellitus, hyperglycemia, hemoglobin A1C and the risk of prosthetic joint infections in total hip and knee arthroplasty. J Arthroplasty 30(3):439–443

    Article  PubMed  Google Scholar 

  13. Sousa R, Muñoz-Mahamud E, Quayle J, Dias da Costa L, Casals C, Scott P, Leite P, Vilanova P, Garcia S, Ramos MH, Dias J, Soriano A, Guyot A (2014) Is asymptomatic bacteriuria a risk factor for prosthetic joint infection? Clin Infect Dis 59(1):41–47

    Article  PubMed  PubMed Central  Google Scholar 

  14. Gou W, Chen J, Jia Y, Wang Y (2014) Preoperative asymptomatic leucocyturia and early prosthetic joint infections in patients undergoing joint arthroplasty. J Arthroplasty 29(3):473–476

    Article  PubMed  Google Scholar 

  15. Bouvet C, Lübbeke A, Bandi C, Pagani L, Stern R, Hoffmeyer P, Uçkay I (2014) Is there any benefit in pre-operative urinary analysis before elective total joint replacement? Bone Joint J 96-B(3):390–394

    Article  CAS  PubMed  Google Scholar 

  16. Hollman F, Wolterbeek N, Veen R (2015) Risk factors for postoperative urinary retention in men undergoing total hip arthroplasty. Orthopedics 38(6):e507–e511

    Article  PubMed  Google Scholar 

  17. Lechleitner M (2016) Adipositas im Alter. Wien Med Wochenschr 166(3–4):143–146

    Article  PubMed  Google Scholar 

  18. Artaza-Artabe I, Sáez-López P, Sánchez-Hernández N, Fernández-Gutierrez N, Malafarina V (2016) The relationship between nutrition and frailty: effects of protein intake, nutritional supplementation, vitamin D and exercise on muscle metabolism in the elderly. A systematic review. Maturitas 93:89–99. doi:10.1016/j.maturitas.2016.04.009

    Article  CAS  PubMed  Google Scholar 

  19. Bozic KJ, Ong K, Lau E, Berry DJ, Vail TP, Kurtz SM, Rubash HE (2013) Estimating risk in Medicare patients with THA: an electronic risk calculator for periprosthetic joint infection and mortality. Clin Orthop Relat Res 471(2):574–583

    Article  PubMed  Google Scholar 

  20. Zhang J, Chen Z, Zheng J, Breusch SJ, Tian J (2015) Risk factors for venous thromboembolism after total hip and total knee arthroplasty: a meta-analysis. Arch Orthop Trauma Surg 135(6):759–772

    Article  PubMed  Google Scholar 

  21. Zhang ZH, Shen B, Yang J, Zhou ZK, Kang PD, Pei FX (2015) Risk factors for venous thromboembolism of total hip arthroplasty and total knee arthroplasty: a systematic review of evidences in ten years. Bmc Musculoskelet Disord 16:24

    Article  PubMed  PubMed Central  Google Scholar 

  22. Minhas SV, Goyal P, Patel AA (2016) What are the risk factors for cerebrovascular accidents after elective orthopaedic surgery? Clin Orthop Relat Res 474(3):611–618

    Article  PubMed  Google Scholar 

  23. Miric A, Inacio MC, Namba RS (2014) The effect of chronic kidney disease on total hip arthroplasty. J Arthroplasty 29(6):1225–1230

    Article  PubMed  Google Scholar 

  24. Courtney PM, Rozell JC, Melnic CM, Lee GC (2015) Who should not undergo short stay hip and knee arthroplasty? Risk factors associated with major medical complications following primary total joint arthroplasty. J Arthroplasty 30(9 Suppl):1–4

    Article  PubMed  Google Scholar 

  25. Moldzio P, Peters J (2017) Perioperative Patientenführung in der Altersendoprothetik. Orthopäde. doi:10.1007/s00132-016-3370-6

    Google Scholar 

  26. Gordon M, Rysinska A, Garland A, Rolfson O, Aspberg S, Eisler T, Garellick G, Stark A, Hailer NP, Sköldenberg O (2016) Increased long-term cardiovascular risk after total hip arthroplasty: a nationwide cohort study. Medicine (Baltimore) 95(6):e2662

    Article  Google Scholar 

  27. Bolognesi MP, Marchant MH Jr, Viens NA, Cook C, Pietrobon R, Vail TP (2008) The impact of diabetes on perioperative patient outcomes after total hip and total knee arthroplasty in the United States. J Arthroplasty 23(6 Suppl 1):92–98

    Article  PubMed  Google Scholar 

  28. Frisch NB, Wessell NM, Charters MA, Yu S, Jeffries JJ, Silverton CD (2014) Predictors and complications of blood transfusion in total hip and knee arthroplasty. J Arthroplasty 29(9 Suppl):189–192

    Article  PubMed  Google Scholar 

  29. Yoshihara H, Yoneoka D (2014) Predictors of allogeneic blood transfusion in total hip and knee arthroplasty in the United States, 2000–2009. J Arthroplasty 29(9):1736–1740

    Article  PubMed  Google Scholar 

  30. Röhrig G (2016) Anemia in the frail, elderly patient. Clin Interv Aging 11:319–326

    Article  PubMed  PubMed Central  Google Scholar 

  31. Zhang Y, Zhang L, Ma X, Jia Y, Wang H, Zhu Y, Liu Y (2016) What is the optimal approach for tranexamic acid application in patients with unilateral total hip arthroplasty? Orthopäde 45(7):616–621

    Article  PubMed  Google Scholar 

  32. Jensen-Dahm C, Palm H, Gasse C, Dahl JB, Waldemar G (2016) Postoperative treatment of pain after hip fracture in elderly patients with dementia. Dement Geriatr Cogn Disord 41(3–4):181–191

    Article  CAS  PubMed  Google Scholar 

  33. Salam AA, Afshan G (2016) Patient refusal for regional anesthesia in elderly orthopedic population: a cross-sectional survey at a tertiary care hospital. J Anaesthesiol Clin Pharmacol 32(1):94–98

    Article  PubMed  PubMed Central  Google Scholar 

  34. Classen T, Zaps D, Landgraeber S, Li X, Jäger M (2013) Assessment and management of chronic pain in patients with stable total hip arthroplasty. Int Orthop 37(1):1–7

    Article  PubMed  Google Scholar 

  35. Bork H (2017) Rehabilitation nach hüft- und knieendoprothetischer Versorgung älterer Menschen. Orthopäde. doi:10.1007/s00132-016-3368-0

    Google Scholar 

  36. Zhu Y, Zhang F, Chen W, Zhang Q, Liu S, Zhang Y (2015) Incidence and risk factors for heterotopic ossification after total hip arthroplasty: a meta-analysis. Arch Orthop Trauma Surg 135(9):1307–1314

    Article  PubMed  Google Scholar 

  37. Buller LT, Best MJ, Klika AK, Barsoum WK (2015) The influence of psychiatric comorbidity on perioperative outcomes following primary total hip and knee arthroplasty; a 17-year analysis of the National Hospital Discharge Survey database. J Arthroplasty 30(2):165–170

    Article  PubMed  Google Scholar 

  38. Weber M, Cabanela ME, Sim FH, Frassica FJ, Harmsen WS (2002) Total hip replacement in patients with Parkinson’s disease. Int Orthop 26(2):66–68

    Article  PubMed  PubMed Central  Google Scholar 

  39. Bin Abd Razak HR, Yung WY (2015) Postoperative delirium in patients undergoing total joint arthroplasty: a systematic review. J Arthroplasty 30(8):1414–1417

    Article  Google Scholar 

  40. Rizk P, Morris W, Oladeji P, Huo M (2016) Review of postoperative delirium in geriatric patients undergoing hip surgery. Geriatr Orthop Surg Rehabil 7(2):100–105

    Article  PubMed  Google Scholar 

  41. Beziz D, Colas S, Collin C, Dray-Spira R, Zureik M (2016) Association between exposure to benzodiazepines and related drugs and survivorship of total hip replacement in arthritis: a population-based cohort study of 246,940 patients. PLOS ONE 11(5):e0155783

    Article  PubMed  PubMed Central  Google Scholar 

  42. Jørgensen CC, Knop J, Nordentoft M, Kehlet H, Lundbeck Foundation Centre for Fast-track Hip and Knee Replacement Collaborative Group (2015) Psychiatric disorders and psychopharmacologic treatment as risk factors in elective fast-track total hip and knee arthroplasty. Anesthesiology 123(6):1281–1291

    Article  PubMed  Google Scholar 

  43. Bottai V, Dell’Osso G, Celli F, Bugelli G, Cazzella N, Cei E, Guido G, Giannotti S (2015) Total hip replacement in osteoarthritis: the role of bone metabolism and its complications. Clin Cases Miner Bone Metab 12(3):247–250

    PubMed  PubMed Central  Google Scholar 

  44. Kirschner S, Hartmann A, Günther KP, Hamann C (2014) Endoprothetische Versorgung bei osteoporoseassoziierter Koxarthrose. Aspekte zur sicheren Patientenversorgung. Orthopäde 43(4):353–364

    Article  CAS  PubMed  Google Scholar 

  45. Riley SA, Spears JR, Smith LS, Mont MA, Elmallah RK, Cherian JJ, Malkani AL (2016) Cementless tapered femoral stems for total hip arthroplasty in octogenarians. J Arthroplasty 31:2810. doi:10.1016/j.arth.2016.05.010.

    Article  PubMed  Google Scholar 

  46. Buch A, Carmeli E, Boker LK, Marcus Y, Shefer G, Kis O, Berner Y, Stern N (2016) Muscle function and fat content in relation to sarcopenia, obesity and frailty of old age – an overview. Exp Gerontol 76:25–32

    Article  PubMed  Google Scholar 

  47. Moore DR (2014) Keeping older muscle “young” through dietary protein and physical activity. Adv Nutr 5(5):599S–607S

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  48. Cvecka J, Tirpakova V, Sedliak M, Kern H, Mayr W, Hamar D (2015) Physical activity in elderly. Eur J Transl Myol 25(4):249–252

    Article  PubMed  PubMed Central  Google Scholar 

  49. Sonoda Y, Sawano S, Kojima Y, Kugo M, Taniguchi M, Maegawa S, Kawasaki T (2016) Comprehensive geriatric assessment of effects of hospitalization and long-term rehabilitation of patients following lower extremity arthroplasty. J Phys Ther Sci 28(4):1178–1187

    Article  PubMed  PubMed Central  Google Scholar 

  50. Morlock MM, Jäger M (2017) Endoprothetik des älteren Menschen, Biomaterialien, Implantatwahl, Verankerungstechnik. Orthopäde. doi:10.1007/s00132-016-3361-7

    Google Scholar 

  51. Pétursson Þ, Edmunds KJ, Gíslason MK, Magnússon B, Magnúsdóttir G, Halldórsson G, Jónsson H Jr, Gargiulo P (2015) Bone mineral density and fracture risk assessment to optimize prosthesis selection in total hip replacement. Comput Math Methods Med 2015:162481. doi:10.1155/2015/162481

    Article  Google Scholar 

  52. Miles B, Walter WL, Kolos E, Waters T, Appleyard R, Gillies RM, Donohoo S, Ruys AJ (2015) A plasma-sprayed titanium proximal coating reduces the risk of periprosthetic femoral fracture in cementless hip arthroplasty. Biomed Mater Eng 25(3):267–278

    CAS  PubMed  Google Scholar 

  53. von Lewinski G, Floerkemeier T (2015) 10-year experience with short stem total hip arthroplasty. Orthopedics 38(3 Suppl):S51–S56

    Article  Google Scholar 

  54. Berend KR, Mirza AJ, Morris MJ, Lombardi AV Jr (2016) Risk of periprosthetic fractures with direct anterior primary total hip arthroplasty. J Arthroplasty 31:2295. doi:10.1016/j.arth.2016.03.007

    Article  PubMed  Google Scholar 

  55. Pitter FT, Jørgensen CC, Lindberg-Larsen M, Kehlet H, Kehlet (2016) Postoperative Morbidity and Discharge Destinations After Fast-Track Hip and Knee Arthroplasty in Patients Older Than 85 Years. Anesth Analg 122(6):1807–1815

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Essen, Hufelandstr. 55, 45247, Essen, Deutschland

    T. Claßen, C. Scheid, S. Landgraeber &  M. Jäger

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  1. T. Claßen
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  2. C. Scheid
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  3. S. Landgraeber
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  4. M. Jäger
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Correspondence to M. Jäger.

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Interessenkonflikt

T. Claßen, C. Scheid und M. Jäger geben an, dass kein Interessenkonflikt besteht. S. Landgraeber gibt an, Beraterverträge mit den Firmen Microport und Wright Medical zu haben sowie Zahlungen für einen Vortrag von Aesculap erhalten zu haben.

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

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Claßen, T., Scheid, C., Landgraeber, S. et al. Besonderheiten beim elektiven Hüftgelenkersatz des älteren Menschen. Orthopäde 46, 25–33 (2017). https://doi.org/10.1007/s00132-016-3364-4

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