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Patientenoptimierung für einen Hüft-TEP-Wechsel

Umgang mit Komorbiditäten

Patient optimization before hip revision arthroplasty:

How to handle comorbidities

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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.

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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

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  1. Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn, Venusberg Campus 1, 53129, Bonn, Deutschland

    Max Jaenisch &  Dieter Christian Wirtz

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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

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