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Erfahrungen und Ergebnisse in der Fast-Track-Endoprothetik

Results and lessons learned in fast-track arthroplasty

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Zusammenfassung

Hintergrund

Fast-Track-Konzepte in der Endoprothetik verstehen sich als Programme zur Optimierung und Homogenisierung perioperativer Abläufe. In der Literatur wird, mit wenigen Ausnahmen, von einer Verkürzung der Hospitalisierungsdauer, einer Abnahme von Mortalität und Komplikationen, einer früheren Mobilisierung und einer gesteigerten Patientenzufriedenheit durch Fast-Track berichtet.

Umsetzung

Für die Umsetzung eines Fast-Track-Konzepts ist die Einbindung und Motivation des gesamten Behandlungsteams notwendig, da die Umsetzung nur einzelner Bausteine eines Fast-Track-Programms nicht zum gewünschten Ziel führt. In der Bewertung von Fast-Track-Programmen sind länderspezifische Regularien zu beachten. Insbesondere fehlen auch Langzeitergebnisse.

Ausblick

Für Deutschland steht bislang eine wissenschaftliche Aufarbeitung aus. Veränderte perioperative Maßnahmen, aber auch eine Verkürzung eines stationären Aufenthaltes, dürfen nicht die aktuell vorhandene hohe Versorgungsqualität in der Endoprothetik reduzieren. Eine mögliche Reduktion der stationären Aufenthaltsdauer bedingt eine Komprimierung, nicht aber zwangsweise eine Verringerung des perioperativen Versorgungsaufwandes für einen Patienten. Aus diesem Grund müssen auf politischer Ebene auch zukünftig Rahmenbedingungen geschaffen werden, die es ermöglichen, die angestrebte hohe Qualität zu erzielen.

Abstract

Background

Fast-track concepts in arthroplasty are understood as programs to optimize and homogenize perioperative procedures. With few exceptions, the literature reports a reduction in hospitalization time, a decrease in mortality and complications, earlier mobilization, and increased patient satisfaction through fast-track programs.

Implementation

The implementation of a fast-track concept requires the involvement and motivation of the entire treatment team, as the implementation of only individual components of a fast-track program does not lead to the desired goal. Country-specific regulations must be taken into account when evaluating fast-track programs. In particular, long-term results are also lacking.

Outlook

For Germany, a scientific review is still pending. Modified perioperative measures but also a shortening of an inpatient stay must not reduce the currently existing high quality of care in arthroplasty. A possible reduction in the length of inpatient stay implies a compression, but not necessarily a reduction in the perioperative care required for a patient. For this reason, the surrounding conditions must also be created at a political level in the future to enable the achievement of the desired high quality.

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Abb. 1

Abbreviations

DRG:

Diagnosis Related Groups

SGB :

Sozialgesetzbuch

Literatur

  1. Husted H, Solgaard S, Hansen TB et al (2010) Care principles at four fast-track arthroplasty departments in Denmark. Dan Med Bull 57:A4166

    PubMed  Google Scholar 

  2. Kehlet H (2013) Fast-track hip and knee arthroplasty. Lancet 381:1600–1602

    Article  Google Scholar 

  3. Husted H (2012) Fast-track hip and knee arthroplasty: clinical and organizational aspects. Acta Orthop Suppl 83:1–39

    Article  Google Scholar 

  4. Leiss F, Götz JS, Maderbacher G, Meyer M, Reinhard J, Zeman F, Grifka J, Greimel F (2021) Excellent functional outcome and quality of life after primary cementless total hip arthroplasty (THA) using an enhanced recovery setup. J Clin Med 10(4):621. https://doi.org/10.3390/jcm10040621

    Article  PubMed  PubMed Central  Google Scholar 

  5. Leiss F, Schindler M, Götz JS, Maderbacher G, Meyer M, Reinhard J, Zeman F, Grifka J, Greimel F (2021) Superior functional outcome and comparable health-related quality of life after enhanced recovery vs. conventional THA: a retrospective matched pair analysis. J Clin Med 10(14):3096–3014. https://doi.org/10.3390/jcm10143096

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Götz JS, Leiss F, Maderbacher G, Meyer M, Reinhard J, Zeman F, Grifka J, Greimel F (2021) Implementing fast-track in total hip arthroplasty: rapid mobilization with low need for pain medication and low pain values : retrospective analysis of 102 consecutive patients. Z Rheumatol. https://doi.org/10.1007/s00393-021-00978-5

    Article  PubMed  PubMed Central  Google Scholar 

  7. Leiss F, Götz JS, Meyer M, Maderbacher G, Reinhard J, Parik L, Grifka J, Greimel F (2021) Differences in femoral component subsidence rate after THA using an uncemented collarless femoral stem: full weight-bearing with an enhanced recovery rehabilitation versus partial weight-bearing. Arch Orthop Trauma Surg. https://doi.org/10.1007/s00402-021-03913-0

    Article  PubMed  PubMed Central  Google Scholar 

  8. Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften S3-Leitlinie Prophylaxe der venösen Thromboembolie (VTE) – 2. komplett überarbeitete Auflage (Stand 15.10. 2015). www.awmf.org/leitlinien/detail/ll/003-001.html. Zugegriffen: 5. Juli 2016

  9. Morrell AT, Layon DR, Scott MJ, Kates SL, Golladay GJ, Patel NK (2021) Enhanced recovery after primary total hip and knee arthroplasty: a systematic review. J Bone Joint Surg Am 103(20):1938–1947. https://doi.org/10.2106/JBJS.20.02169

    Article  PubMed  Google Scholar 

  10. Ripollés-Melchor J, Abad-Motos A, Díez-Remesal Y, Aseguinolaza-Pagola M, Padin-Barreiro L, Sánchez-Martín R, Logroño-Egea M, Catalá-Bauset JC, García-Orallo S, Bisbe E, Martín N, Suárez-de-la-Rica A, Cuéllar-Martínez AB, Gil-Trujillo S, Estupiñán-Jiménez JC, Villanova-Baraza M, Gil-Lapetra C, Pérez-Sánchez P, Rodríguez-García N, Ramiro-Ruiz A, Farré-Tebar C, Martínez-García A, Arauzo-Pérez P, García-Pérez C, Abad-Gurumeta A, Miñambres-Villar MA, Sánchez-Campos A, Jiménez-López I, Tena-Guerrero JM, Marín-Peña O, Sánchez-Merchante M, Vicente-Gutiérrez U, Cassinello-Ogea MC, Ferrando-Ortolá C, Berges-Gutiérrez H, Fernanz-Antón J, Gómez-Ríos MA, Bordonaba-Bosque D, Ramírez-Rodríguez JM, García-Erce JA, Aldecoa C, Postoperative Outcomes Within Enhanced Recovery After Surgery Protocol in Elective Total Hip and Knee Arthroplasty (POWER2) Study Investigators Group for the Spanish Perioperative Audit and Research Network (REDGERM). (2020) Association between use of enhanced recovery after surgery protocol and postoperative complications in total hip and knee arthroplasty in the postoperative outcomes within enhanced recovery after surgery protocol in elective total hip and knee Arthroplasty study (POWER2). JAMA Surg 155(4):e196024. https://doi.org/10.1001/jamasurg.2019.6024

    Article  PubMed  PubMed Central  Google Scholar 

  11. Larsen K, Hvass KE, Hansen TB, Thomsen PB, Søballe K (2008) Effectiveness of accelerated perioperative care and rehabilitation intervention compared to current intervention after hip and knee arthroplasty. A before-after trial of 247 patients with a 3-month follow-up. BMC Musculoskelet Disord 9:59. https://doi.org/10.1186/1471-2474-9-59

    Article  PubMed  PubMed Central  Google Scholar 

  12. Khan SK, Malviya A, Muller SD, Carluke I, Partington PF, Emmerson KP, Reed MR (2014) Reduced short-term complications and mortality following Enhanced Recovery primary hip and knee arthroplasty: results from 6,000 consecutive procedures. Acta Orthop 85(1):26–31. https://doi.org/10.3109/17453674.2013.874925

    Article  PubMed  PubMed Central  Google Scholar 

  13. Pamilo KJ, Torkki P, Peltola M, Pesola M, Remes V, Paloneva J (2018) Fast-tracking for total knee replacement reduces use of institutional care without compromising quality. Acta Orthop 89(2):184–189. https://doi.org/10.1080/17453674.2017.1399643

    Article  PubMed  Google Scholar 

  14. Berg U, BüLow E, Sundberg M, Rolfson O (2018) No increase in readmissions or adverse events after implementation of fast-track program in total hip and knee replacement at 8 Swedish hospitals: an observational before-and-after study of 14,148 total joint replacements 2011–2015. Acta Orthop 89(5):522–527. https://doi.org/10.1080/17453674.2018.1492507

    Article  PubMed  PubMed Central  Google Scholar 

  15. Garriga C, Murphy J, Leal J, Price A, Prieto-Alhambra D, Carr A, Arden NK, Rangan A, Cooper C, Peat G, Fitzpatrick R, Barker K, Judge A (2019) Impact of a national enhanced recovery after surgery programme on patient outcomes of primary total knee replacement: an interrupted time series analysis from “The National Joint Registry of England, Wales, Northern Ireland and the Isle of Man”. Osteoarthritis Cartilage 27(9):1280–1293. https://doi.org/10.1016/j.joca

    Article  CAS  PubMed  Google Scholar 

  16. Jiang HH, Jian XF, Shangguan YF, Qing J, Chen LB (2019) Effects of enhanced recovery after surgery in total knee Arthroplasty for patients older than 65 years. Orthop Surg 11(2):229–235. https://doi.org/10.1111/os.12441

    Article  PubMed  PubMed Central  Google Scholar 

  17. Tan NLT, Hunt JL, Gwini SM (2018) Does implementation of an enhanced recovery after surgery program for hip replacement improve quality of recovery in an Australian private hospital: a quality improvement study. BMC Anesthesiol 18(1):64. https://doi.org/10.1186/s12871-018-0525-5

    Article  PubMed  PubMed Central  Google Scholar 

  18. den Hertog A, Gliesche K, Timm J, Mühlbauer B, Zebrowski S (2012) Pathway-controlled fast-track rehabilitation after total knee arthroplasty: a randomized prospective clinical study evaluating the recovery pattern, drug consumption, and length of stay. Arch Orthop Trauma Surg 132(8):1153–1163. https://doi.org/10.1007/s00402-012-1528-1

    Article  Google Scholar 

  19. Petersen PB, Kehlet H, Jørgensen CC, Lundbeck Foundation Centre for Fast-track Hip and Knee Replacement Collaborative Group (2020) Improvement in fast-track hip and knee arthroplasty: a prospective multicentre study of 36,935 procedures from 2010 to 2017. Sci Rep 10(1):21233. https://doi.org/10.1038/s41598-020-77127-6

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Zhu S, Qian W, Jiang C, Ye C, Chen X (2017) Enhanced recovery after surgery for hip and knee arthroplasty: a systematic review and meta-analysis. Postgrad Med J 93(1106):736–742. https://doi.org/10.1136/postgradmedj-2017-134991

    Article  PubMed  Google Scholar 

  21. Petersen MK, Madsen C, Andersen NT, Søballe K (2006) Efficacy of multimodal optimization of mobilization and nutrition in patients undergoing hip replacement: a randomized clinical trial. Acta Anaesthesiol Scand 50(6):712–717. https://doi.org/10.1111/j.1399-6576.2006.01040.x

    Article  CAS  PubMed  Google Scholar 

  22. Auyong DB, Allen CJ, Pahang JA, Clabeaux JJ, MacDonald KM, Hanson NA (2015) Reduced length of hospitalization in primary total knee arthroplasty patients using an updated enhanced recovery after orthopedic surgery (ERAS) pathway. J Arthroplasty 30(10):1705–1709. https://doi.org/10.1016/j.arth.2015.05.007

    Article  PubMed  Google Scholar 

  23. Christelis N, Wallace S, Sage CE, Babitu U, Liew S, Dugal J, Nyulasi I, Mutalima N, Tran T, Myles PS (2015) An enhanced recovery after surgery program for hip and knee arthroplasty. Med J Aust 202(7):363–368. https://doi.org/10.5694/mja14.00601

    Article  PubMed  Google Scholar 

  24. Malviya A, Martin K, Harper I, Muller SD, Emmerson KP, Partington PF, Reed MR (2011) Enhanced recovery program for hip and knee replacement reduces death rate. Acta Orthop 82(5):577–581. https://doi.org/10.3109/17453674.2011.618911

    Article  PubMed  PubMed Central  Google Scholar 

  25. Stambough JB, Nunley RM, Curry MC, Steger-May K, Clohisy JC (2015) Rapid recovery protocols for primary total hip arthroplasty can safely reduce length of stay without increasing readmissions. J Arthroplasty 30(4):521–526. https://doi.org/10.1016/j.arth.2015.01.023

    Article  PubMed  PubMed Central  Google Scholar 

  26. Stowers MD, Manuopangai L, Hill AG, Gray JR, Coleman B, Munro JT (2016) Enhanced recovery after surgery in elective hip and knee arthroplasty reduces length of hospital stay. ANZ J Surg 86(6):475–479. https://doi.org/10.1111/ans.13538

    Article  PubMed  Google Scholar 

  27. Berg U, W‑Dahl A, Rolfson O, Nauclér E, Sundberg M, Nilsdotter A (2020) Influence of fast-track programs on patient-reported outcomes in total hip and knee replacement (THR/TKR) at Swedish hospitals 2011–2015: an observational study including 51,169 THR and 8,393 TKR operations. Acta Orthop 91(3):306–312. https://doi.org/10.1080/17453674.2020.1733375

    Article  PubMed  PubMed Central  Google Scholar 

  28. Berg U, W‑Dahl A, Nilsdotter A, Nauclér E, Sundberg M, Rolfson O (2021) Fast-track programs in total hip and knee replacement at Swedish hospitals-influence on 2‑year risk of revision and mortality. J Clin Med 10(8):1680. https://doi.org/10.3390/jcm10081680

    Article  PubMed  PubMed Central  Google Scholar 

  29. Amlie E, Lerdal A, Gay CL, Høvik Ø, Nordsletten L, Dimmen S (2016) A trend for increased risk of revision surgery due to deep infection following fast-track hip arthroplasty. Adv Orthop. https://doi.org/10.1155/2016/7901953

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Orthopädische Klinik für die Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Deutschland

    Günther Maderbacher,  Matthias Meyer,  Joachim Grifka,  Dominik Holzapfel &  Felix Greimel

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  1. Günther Maderbacher
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  2. Matthias Meyer
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  3. Joachim Grifka
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  4. Dominik Holzapfel
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Correspondence to Günther Maderbacher.

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Interessenkonflikt

G. Maderbacher, M. Meyer, D. Holzapfel und F. Greimel geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt.

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Maderbacher, G., Meyer, M., Grifka, J. et al. Erfahrungen und Ergebnisse in der Fast-Track-Endoprothetik. Orthopäde 51, 374–379 (2022). https://doi.org/10.1007/s00132-022-04245-6

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