S2k-Leitlinie: Indikation Knieendoprothese

Lützner, Jörg; Lange, Toni; Schmitt, Jochen; Kopkow, Christian; Aringer, Martin; Böhle, E.; Bork, Hartmut; Dreinhöfer, Karsten; Friederich, Niklaus F.; Gravius, Sascha; Heller, Karl-Dieter; Hube, Robert; Kirschner, S.; Kladny, Bernd; Kremer, M.; Linke, Manfred; Malzahn, Jürgen; Sabatowski, Rainer; Scharf, Hanns‐Peter; Stöve, J.; Wagner, Richard; Günther, K.-P.

doi:10.1007/s00132-018-3612-x

Cited by 30 publications

(18 citation statements)

References 14 publications

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“…11 – 15 Failed conservative therapy, pain, loss of function, and radiological changes are considered in the decision to perform total hip replacement (THR) or total knee replacement (TKR) surgeries, 12 , 13 , 16 – 20 which are effective and cost-effective procedures for people with severe unresponsiveness to OA conservative therapy, 21 , 22 also recommended in German guidelines. 23 , 24 …”

Section: Introductionmentioning

confidence: 99%

Prevalence and treatment of hip and knee osteoarthritis in people aged 60 years or older in Germany: an analysis based on health insurance claims data

Postler

Ramos

Goronzy

et al. 2018

CIA

104

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ObjectiveOsteoarthritis (OA) is highly prevalent throughout the world, especially in the elderly population, and is strongly associated with patients’ frailty. However, little is known about the prevalence and treatment of OA in elderly patients in routine clinical care in Germany.Materials and methodsAs a part of Linking Patient-Reported Outcomes with CLAIms Data for Health Services Research in Rheumatology (PROCLAIR), a cross-sectional study using claims data from a large Germany statutory health insurance (BARMER) was conducted. We included people aged 60 years or older and assessed the prevalence of OA of the hip or knee, defined as having outpatient diagnoses (ICD: M16 or M17) in at least two quarters of 2014. The use of conservative treatment, including analgesics and physical therapy, and total joint replacement was studied. Analyses were stratified by age, sex, comorbidities, and level of care dependency defined by social law.ResultsA total of 595,754 patients (mean age: 74.9 years; 69.8% female) were diagnosed with OA (21.8%), with the highest prevalence in those between 80 and 89 years (31.0%) and in females compared to males (23.9% vs 18.3%). Prevalence decreased with increasing level of care dependency from 30.5% in patients with a low level (0/1) to 18.7% in the highest level of care dependency. A total of 63.4% of the patients with OA received analgesics, with higher use with increasing age. Physical therapy was prescribed to 43.1% of the patients, but use decreased with age. In all, 5.3% of the patients received total joint replacement in 2014.ConclusionThe lower frequency of coded OA with increasing level of care dependency may reflect underdiagnosis, and patients with many other medical problems seem to be at risk for inadequate recognition and treatment of their OA.

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Section: Introductionmentioning

confidence: 99%

Prevalence and treatment of hip and knee osteoarthritis in people aged 60 years or older in Germany: an analysis based on health insurance claims data

Postler

Ramos

Goronzy

et al. 2018

CIA

104

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“…Pain is the most common factor indicating the need for surgery [48], and is suggested to be the most common cause of dissatisfaction after knee arthroplasty [9,15,16]. In our study, participants expressed their anxiety about long-lasting pain.…”

Section: Discussionmentioning

confidence: 67%

Why are patients discontented after total knee arthroplasty when the orthopedic surgeons are contented?

Mahdi

Svantesson

Wretenberg

et al. 2019

Preprint

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Background Total knee arthroplasty is a common procedure with generally good results. However, there are still patients who are discontented without known explanation. Contentment and discontentment have previously been captured by quantitative designs, but there is a lack of qualitative studies regarding these patients’ experiences. Qualitative knowledge might be useful in creating strategies to decrease the discontentment rate. Methods Of the 348 patients who responded to a letter asking if they were contented or discontented with their surgery, 61 (18%) reported discontentment. After excluding patients with documented complications and those who declined to participate, semi-structured interviews were conducted with 44 patients. The interviews were analyzed according to qualitative content analysis. The purpose was to describe patients’ experiences of discontentment one year after total knee arthroplasty. Results The patients experienced unfulfilled expectations and needs regarding unresolved and new problems, limited independence, and need for buttresses. They were bothered by pain and stiffness, and worried that changes were complications as a result of surgery. They described inability to perform daily activities and valued activities. They also felt a need for buttresses, and a lack of respect and continuity, support from health care, and information adapted to their needs. Conclusion Patient expectation seems to be the major contributing factor in patient discontentment after knee replacement surgery. This qualitative study sheds light on the meaning of unfulfilled expectations, in contrast to previous quantitative studies. The elements of unfulfilled expectations need to be dealt with both on the individual staff level and on the organizational level. For instance, increased continuity of healthcare staff and facilities may help to improve patient contentment after surgery.

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“…Die aktuelle Leitlinie der Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF) berücksichtigt die Ziele des Patienten als einen zentralen Aspekt bei der Indikationsstellung zur KTEP (Abb. 1 ; [ 30 ]). Ein wichtiger Prädiktor für die Patientenunzufriedenheit nach einer KTEP sind nicht erfüllte Erwartungen (10-fach höheres Risiko) [ 8 ].…”

Section: Knietotalendoprothetik: Aktuelle Entwicklungen Und Indikationunclassified

Bikondylärer Oberflächenersatz des Kniegelenkes beim jungen Patienten – ein Update

Egloff¹,

Hirschmann

Moret

et al. 2021

Orthopäde

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ZusammenfassungDie Zahl der durchgeführten Knietotalendoprothesen (KTEP) nimmt jedes Jahr kontinuierlich zu. Ungefähr 10 % davon betreffen Patienten unter 55 Jahren, obwohl bekannt ist, dass in dieser Altersgruppe die Zufriedenheit und die funktionellen Ergebnisse geringer und die Revisionsrate höher ausfällt. Vermehrte Aktivität und erhöhtes Anspruchsdenken machen die Endoprothetik in dieser Altersgruppe zu einer besonderen Herausforderung. Gleichzeitig ist der Anteil posttraumatischer Gonarthrosen deutlich erhöht, was in Anbetracht ligamentärer und knöcherner Vorschäden eine schwierigere operative Versorgung bedeutet. Bei fortgeschrittenen Arthrosen in mehreren Kompartimenten mit/ohne begleitender ligamentärer Instabilität muss jedoch ein totalendoprothetischer Ersatz auch bei jüngeren Patienten erwogen werden. Die sorgfältige Indikationsstellung für die KTEP und die eingehende Patientenaufklärung (Chancen, Risiken, erreichbare Leistungsfähigkeit in Beruf und Alltag) sind gerade bei jüngeren Patienten starke Prädiktoren für ein gutes Resultat.

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S2k-Leitlinie: Indikation Knieendoprothese

Cited by 30 publications

References 14 publications

Prevalence and treatment of hip and knee osteoarthritis in people aged 60 years or older in Germany: an analysis based on health insurance claims data

Prevalence and treatment of hip and knee osteoarthritis in people aged 60 years or older in Germany: an analysis based on health insurance claims data

Why are patients discontented after total knee arthroplasty when the orthopedic surgeons are contented?

Bikondylärer Oberflächenersatz des Kniegelenkes beim jungen Patienten – ein Update

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