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Fast-Track-Strategien in der Hüftendoprothetik

Fast track strategies in hip arthroplasty

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Zusammenfassung

Hintergrund

Fast-Track-Endoprothetik gewinnt im deutschsprachigen Raum immer mehr an Akzeptanz. Fast-Track-Programme versprechen durch eine Optimierung der Behandlungsprozesse eine schnellere Genesung, eine höhere Patientenzufriedenheit, eine Verbesserung der Qualität und eine Reduktion der Verweildauer.

Ziel der Arbeit

Es sollen die Philosophie und Behandlungsprinzipien der Fast-Track-Hüftendoprothetik während der prä-, intra- und postoperativen Phase unter Einbeziehung der derzeitigen Evidenzlage dargestellt werden. Die Herausforderungen im deutschen Gesundheitssystem sollen diskutiert werden.

Material und Methoden

Neben der Darstellung eigener Daten zum Patientenseminar und zur opioidsparenden Schmerztherapie werden die wesentlichen Arbeiten zum Thema Fast-Track in der Hüftendoprothetik aus einer Pubmed-Literaturrecherche diskutiert.

Ergebnisse

Fast-Track-Konzepte können nur durch eine enge interdisziplinäre Zusammenarbeit erfolgreich umgesetzt werden. Präoperativ kann ein Patientenseminar helfen, den Patienten besser auf die Operation vorzubereiten. Postoperativ nehmen die Frühmobilisation und die Schmerztherapie eine zentrale Rolle ein, wobei eine deutliche Reduktion der Opioide erreicht werden kann.

Diskussion

Fast-Track-Hüftendoprothetik macht ein Umdenken bezüglich traditioneller Behandlungsprinzipien notwendig und fordert ein hohes Maß an interdisziplinärer Zusammenarbeit. Insbesondere aufgrund der Besonderheiten des Gesundheitssystems (DRG-System und stationäre Rehabilitation) hat eine flächendeckende Etablierung in Deutschland bisher nicht stattgefunden.

Abstract

Background

Fast track arthroplasty is becoming increasingly accepted in German-speaking countries. By optimizing treatment processes fast track programs promise faster recovery, increased patient satisfaction, quality improvement and reduction in the length of hospital stay.

Objectives

The philosophy and treatment principles of fast track hip arthroplasty during the pre, intra and postoperative phase are described in the light of the current body of evidence. The challenges concerning fast track arthroplasty within the German health system are discussed.

Material and methods

Besides presenting our own data concerning a patient seminar and an opiate saving pain treatment, the most relevant literature related to fast track hip arthroplasty from a pubmed search is discussed.

Results

Fast track concepts can only be successfully implemented through close interdisciplinary team work. Preoperatively, a patient seminar can help to prepare patients better for surgery. Postoperatively, early mobilisation and pain treatment play a central role, whereat a clear reduction in opiate application can be achieved.

Conclusion

Fast track hip arthroplasty makes rethinking with respect to traditional treatment principles necessary and demands a high degree of interdisciplinary team work. Particularly, as result of the specifics of the health system (DRG system and stationary rehabilitation), a nationwide establishment in Germany has not taken place so far.

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Abbreviations

AHB:

Anschlussrehabilitation

AMIS :

„Anterior minimally invasive surgery“

COX2 :

Cyclooxygenase-2

CRP :

C-reaktives Protein

DRG :

Diagnosis Related Groups

HTEP :

Hüfttotalendoprothese

IL :

Interleukin

LIA :

Lokale Infiltrationsanästhesie

MIS :

Minimalinvasive Operation

NSAR :

Nichtsteroidale Antirheumatika

PONV :

Postoperative Übelkeit und Erbrechen

TXA :

Tranexamsäure

VAS :

Visuelle Analogskala

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Authors and Affiliations

  1. Klinik für Orthopädie und Unfallchirurgie, Evangelisches Waldkrankenhaus Spandau, Stadtrandstraße 555, 13589, Berlin, Deutschland

    U. Nöth MHBA, T. Geiser, T. Kranich, E. von Rottkay, J. C. Reichert & L. Rackwitz

  2. Klinik für Anästhesie und interdisziplinäre Intensivmedizin, Evangelisches Waldkrankenhaus Spandau, Berlin, Deutschland

    M. Reyle-Hahn

Authors
  1. U. Nöth MHBA
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  2. T. Geiser
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  3. T. Kranich
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  4. E. von Rottkay
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  5. J. C. Reichert
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  6. M. Reyle-Hahn
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  7. L. Rackwitz
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Corresponding author

Correspondence to U. Nöth MHBA.

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Interessenkonflikt

U. Nöth, T. Geiser, T. Kranich, E. von Rottkay, J. Christan Reichert, M. Reyle-Hahn und L. Rackwitz geben an, dass kein Interessenkonflikt besteht.

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

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Nöth, U., Geiser, T., Kranich, T. et al. Fast-Track-Strategien in der Hüftendoprothetik. Orthopäde 48, 330–336 (2019). https://doi.org/10.1007/s00132-019-03697-7

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  • DOI: https://doi.org/10.1007/s00132-019-03697-7

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