Evidence-based and Patient-centered Indication for Knee Arthroplasty - Update of the Guideline

被引:0
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作者
Luetzner, Joerg [1 ]
Deckert, Stefanie [2 ,3 ]
Lange, Toni [2 ,3 ]
Postler, Anne Elisabeth [1 ]
Aringer, Martin [3 ,4 ]
Berth, Hendrik [5 ,6 ]
Dreinhoefer, Karsten E. [7 ,8 ]
Guenther, Klaus-Peter [9 ]
Heller, Karl-Dieter [10 ]
Hube, Robert [11 ]
Kirschner, Stephan [12 ]
Kladny, Bernd [13 ]
Kopkow, Christian [14 ]
Sabatowski, Rainer [3 ,15 ]
Stoeve, Johannes [16 ]
Wagner, Richard [17 ]
Luetzner, Cornelia [1 ]
机构
[1] Tech Univ Dresden, Univ Ctr Orthopadie Unfall & Plast Chirurg, Univ klinikum Carl Gustav Carus, Fetscherstr 74, D-01307 Dresden, Germany
[2] Tech Univ Dresden, Zentrum Evidenzbasierte Gesundheitsversorgung, Univ klinikum, Dresden, Germany
[3] Tech Univ Dresden, Med Fak Carl Gustav Carus, Dresden, Germany
[4] Tech Univ Dresden, Med Klin & Poliklin 3, Bereich Rheumatol, Univ klinikum, Dresden, Germany
[5] Univ Klinikum Carl Gustav Carus Dresden, Psychosoziale Med & Entwicklungsneurowissensch, Dresden, Germany
[6] St Josef Stift, Reha Zentrum St Josef Stift, Sendenhorst, Germany
[7] Charite, Ctr Sportwissensch & Sportmed CSSB, Berlin, Germany
[8] Med Pk Berlin Humboldtmuhle, Abt Orthopadie & Unfall Chirurg, Berlin, Germany
[9] Univ Klinikum Carl Gustav Carus Dresden, Klin & Poliklin Orthopadie, Dresden, Germany
[10] Kliniken Herzogin Elisabeth Heim HEH, Orthopad Klin Braunschweig, Braunschweig, Germany
[11] OCM Klin Munchen, Orthopad Chirurg, Munich, Germany
[12] Sankt Vincentius Kliniken Karlsruhe, Orthopad Klin, Karlsruhe, Germany
[13] Fachklin Herzogenaurach, Orthopadie, Herzogenaurach, Germany
[14] Brandenburg Tech Univ Cottbus Senftenberg, Fachgebiet Therapiewissensch, Cottbus, Germany
[15] Tech Univ Dresden, Univ Schmerz Ctr, Univ klinikum, Dresden, Germany
[16] St Marien Hosp, Orthopadie & Unfallchirurg, Ludwigshafen, Germany
[17] AGAPLES Markus Krankenhaus, Klin Orthopadie & Unfallchirurg, Frankfurter Diakonie Kliniken gGmBH, Frankfurt, Germany
关键词
knee arthroplasty; unicondylar knee arthroplasty; knee osteoarthritis; clinical practice guideline; indication; HIP; OSTEOARTHRITIS;
D O I
10.1055/a-2288-7254
中图分类号
R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学(修复外科学)];
学科分类号
摘要
Background Knee arthroplasty is one of the most frequently performed operations in Germany, with approximately 170000 procedures per year. It is therefore essential that physicians should adhere to an appropriate, and patient-centered indication process. The updated guideline indication criteria for knee arthroplasty (EKIT-Knee) contain recommendations, which are based on current evidence and agreed upon by a broad consensus panel. For practical use, the checklist has also been updated. Methods For this guideline update, a systematic literature research was conducted in order to analyse (inter-)national guidelines and systematic reviews focusing on osteoarthritis of the knee and knee arthroplasty, to answer clinically relevant questions on diagnostic, predictors of outcome, risk factors and contraindications. Results Knee arthroplasty should solely be performed in patients with radiologically proven moderate or severe osteoarthritis of the knee (Kellgren-Lawrence grade 3 or 4), after previous non-surgical treatment for at least three months, in patients with high subjective burden with regard to knee-related complaints and after exclusion of possible contraindications (infection, comorbidities, BMI >= 40 kg/m(2)). Modifiable risk factors (such as smoking, diabetes mellitus, anaemia) should be addressed and optimised in advance. After meeting current guideline indications, a shared decision-making process between patients and surgeons is recommended, in order to maintain high quality surgical management of patients with osteoarthritis of the knee. Conclusions The update of the S2k-guideline was expanded to include unicondylar knee arthroplasty, the preoperative optimisation of modifiable risk factors was added and the main indication criteria were specified.
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页数:7
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