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Z Orthop Unfall 2018; 156(01): 41-45
DOI: 10.1055/s-0043-119897
Übersicht
Georg Thieme Verlag KG Stuttgart · New York

Perioperatives Management in der Knieendoprothetik

Perioperative Management in Total Knee Arthroplasty
Robert Hube
1   Orthopädische Chirurgie, OCM-Klinik München
,
Hermann O. Mayr
2   Orthopädie, Schön Klinik München-Harlaching
,
Philipp von Roth
3   Centrum für Muskuloskeletale Chirurgie, Charité – Universitätsmedizin Berlin
,
Michael Najfeld
1   Orthopädische Chirurgie, OCM-Klinik München
,
Kathi Thiele
3   Centrum für Muskuloskeletale Chirurgie, Charité – Universitätsmedizin Berlin
› Author Affiliations
Further Information

Publication History

Publication Date:
22 November 2017 (online)

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Zusammenfassung

Der Artikel befasst sich mit 4 wesentlichen Aspekten des perioperativen Managements und deren Relevanz in der Knieendoprothetik. Aufgrund der Anzahl unzufriedener Patienten nach Knieendoprothetik scheint eine Optimierung der Prozesse notwendig. Neben der Patientenvorbereitung, der Mobilisierung, der operativen Technik und Implantatwahl kommt dem perioperativen Management eine bedeutende Rolle zu. Hierzu gehören die Anlage einer Blutsperre, die Verwendung von Drainagen, die Nutzung von Tranexamsäure und die Schmerztherapie. Diese werden im vorliegenden Beitrag ausführlich dargestellt.

Abstract

The themes of this paper are the clinical relevance and technique of perioperative management in total knee arthroplasty. Due to the number of unsatisfied patients after knee arthroplasty, optimisation of processes seems to be necessary. Beside patient preparation and rehabilitation, the surgical technique and implant choice in perioperative management are important. This means the use of tourniquet and drains, the application of tranexamic acid and pain management. These items are presented and discussed in detail in this paper.

Schlüsselwörter

Knieendoprothetik - Blutsperre - Tranexamsäure - Schmerztherapie - Drainagen

Key words

total knee arthroplasty - tourniquet - tranexamic acid - pain management - drains
 

  • Literatur

  • 1 Kurtz SM, Lau E, Ong K. et al. Future young patient demand for primary and revision joint replacement: national projections from 2010 to 2030. Clin Orthop Relat Res 2009; 467: 2606-2612 doi:10.1007/s11999-009-0834-6
    CrossrefPubMedGoogle Scholar
  • 2 Callaghan JJ, Beckert MW, Hennessy DW. et al. Durability of a cruciate-retaining TKA with modular tibial trays at 20 years. Clin Orthop Relat Res 2013; 471: 109-117 doi:10.1007/s11999-012-2401-9
    CrossrefPubMedGoogle Scholar
  • 3 Goh GSH, Liow MHL, Bin Abd Razak HR. et al. Patient-reported outcomes, quality of life, and satisfaction rates in young patients aged 50 years or younger after total knee arthroplasty. J Arthroplasty 2017; 32: 419-425 doi:10.1016/j.arth.2016.07.043
    CrossrefPubMedGoogle Scholar
  • 4 Robertsson O, Dunbar M, Pehrsson T. et al. Patient satisfaction after knee arthroplasty: a report on 27,372 knees operated on between 1981 and 1995 in Sweden. Acta Orthop Scand 2000; 71: 262-267 doi:10.1080/000164700317411852
    CrossrefPubMedGoogle Scholar
  • 5 Sedrakyan A, Romero L, Graves S. et al. Survivorship of hip and knee implants in pediatric and young adult populations: analysis of registry and published data. J Bone Joint Surg Am 2014; 96 (Suppl. 01) S73-S78 doi:10.2106/JBJS.N.00541
    PubMedGoogle Scholar
  • 6 Pfitzner T, von Roth P, Voerkelius N. et al. Influence of the tourniquet on tibial cement mantle thickness in primary total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2016; 24: 96-101 doi:10.1007/s00167-014-3341-6
    CrossrefPubMedGoogle Scholar
  • 7 Hersekli MA, Akpinar S, Ozkoc G. et al. The timing of tourniquet release and its influence on blood loss after total knee arthroplasty. Int Orthop 2004; 28: 138-141 doi:10.1007/s00264-004-0550-5
    CrossrefPubMedGoogle Scholar
  • 8 Christodoulou AG, Ploumis AL, Terzidis IP. et al. The role of timing of tourniquet release and cementing on perioperative blood loss in total knee replacement. Knee 2004; 11: 313-317 doi:10.1016/j.knee.2003.09.005
    CrossrefPubMedGoogle Scholar
  • 9 Kato N, Nakanishi K, Yoshino S. et al. Abnormal echogenic findings detected by transesophageal echocardiography and cardiorespiratory impairment during total knee arthroplasty with tourniquet. Anesthesiology 2002; 97: 1123-1128
    CrossrefPubMedGoogle Scholar
  • 10 Parmet JL, Berman AT, Horrow JC. et al. Thromboembolism coincident with tourniquet deflation during total knee arthroplasty. Lancet 1993; 341: 1057-1058
    CrossrefPubMedGoogle Scholar
  • 11 Alcelik IA, Blomfield MI, Diana G. et al. A comparison of short-term outcomes of minimally invasive computer-assisted vs. minimally invasive conventional instrumentation for primary total knee arthroplasty: a systematic review and meta-analysis. J Arthroplasty 2016; 31: 410-418 doi:10.1016/j.arth.2015.09.013
    CrossrefPubMedGoogle Scholar
  • 12 Katsumata S, Nagashima M, Kato K. et al. Changes in coagulation-fibrinolysis marker and neutrophil elastase following the use of tourniquet during total knee arthroplasty and the influence of neutrophil elastase on thromboembolism. Acta Anaesthesiol Scand 2005; 49: 510-516 doi:10.1111/j.1399-6576.2005.00621.x
    CrossrefPubMedGoogle Scholar
  • 13 Benoni G, Fredin H. Fibrinolytic inhibition with tranexamic acid reduces blood loss and blood transfusion after knee arthroplasty: a prospective, randomised, double-blind study of 86 patients. J Bone Joint Surg Br 1996; 78: 434-440
    PubMedGoogle Scholar
  • 14 Ho KM, Ismail H. Use of intravenous tranexamic acid to reduce allogeneic blood transfusion in total hip and knee arthroplasty: a meta-analysis. Anaesth Intensive Care 2003; 31: 529-537
    CrossrefPubMedGoogle Scholar
  • 15 Yuan ZF, Yin H, Ma WP. et al. The combined effect of administration of intravenous and topical tranexamic acid on blood loss and transfusion rate in total knee arthroplasty: combined tranexamic acid for TKA. Bone Joint Res 2016; 5: 353-361 doi:10.1302/2046-3758.58.BJR-2016-0001.R2
    CrossrefPubMedGoogle Scholar
  • 16 Husted H, Gromov K, Malchau H. et al. Traditions and myths in hip and knee arthroplasty. Acta Orthop 2014; 85: 548-555 doi:10.3109/17453674.2014.971661
    CrossrefPubMedGoogle Scholar
  • 17 Madsen RV, Nielsen CS, Kallemose T. et al. Low risk of thromboembolic events after routine administration of tranexamic acid in hip and knee arthroplasty. J Arthroplasty 2017; 32: 1298-1303 doi:10.1016/j.arth.2016.10.015
    CrossrefPubMedGoogle Scholar
  • 18 Whiting DR, Duncan CM, Sierra RJ. et al. Tranexamic acid benefits total joint arthroplasty patients regardless of preoperative hemoglobin value. J Arthroplasty 2015; 30: 2098-2101 doi:10.1016/j.arth.2015.05.050
    CrossrefPubMedGoogle Scholar
  • 19 Delanois RE, Gwam C, Mistry JB. et al. Intraarticular administration of tranexamic acid is safe and effective in total knee arthroplasty patients at high-risk for thromboembolism. Surg Technol Int 2016; 30: 279-283
    PubMedGoogle Scholar
  • 20 Nielsen CS, Jans Ø, Ørsnes T. et al. Combined intra-articular and intravenous tranexamic acid reduces blood loss in total knee arthroplasty: a randomized, double-blind, placebo-controlled trial. J Bone Joint Surg Am 2016; 98: 835-841 doi:10.2106/JBJS.15.00810
    Google Scholar
  • 21 von Roth P, Treskatsch L, Kaufner L. et al. Die intraoperative Gabe von Tranexamsäure (Update 5/2017). AE-Handlungsempfehlung. Im Internet: http://www.ae-germany.com/index-php/ae-handlungsempfehlung Stand: 24.05.2017
    PubMedGoogle Scholar
  • 22 Ben-David B, Schmalenberger K, Chelly JE. Analgesia after total knee arthroplasty: is continuous sciatic blockade needed in addition to continuous femoral blockade?. Anesth Analg 2004; 98: 747-749 table of contents
    PubMedGoogle Scholar
  • 23 Sinatra RS, Torres J, Bustos AM. Pain management after major orthopaedic surgery: current strategies and new concepts. J Am Acad Orthop Surg 2002; 10: 117-129
    CrossrefPubMedGoogle Scholar
  • 24 Fowler SJ, Symons J, Sabato S. et al. Epidural analgesia compared with peripheral nerve blockade after major knee surgery: a systematic review and meta-analysis of randomized trials. Br J Anaesth 2008; 100: 154-164 doi:10.1093/bja/aem373
    CrossrefPubMedGoogle Scholar
  • 25 Kerr DR, Kohan L. Local infiltration analgesia: a technique for the control of acute postoperative pain following knee and hip surgery: a case study of 325 patients. Acta Orthop 2008; 79: 174-183 doi:10.1080/17453670710014950
    CrossrefPubMedGoogle Scholar
  • 26 Schotanus MGM, Bemelmans YFL, van der Kuy PHM. et al. No advantage of adrenaline in the local infiltration analgesia mixture during total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2015; 82: 441-446 doi:10.1007/s00167-015-3723-4
    PubMedGoogle Scholar
  • 27 Andersen KV, Nikolajsen L, Daugaard H. et al. Local infiltration analgesia is not improved by postoperative intra-articular bolus injections for pain after total hip arthroplasty. Acta Orthop 2015; 86: 647-653
    Google Scholar
  • 28 Kehlet H, Andersen LØ. Local infiltration analgesia in joint replacement: the evidence and recommendations for clinical practice. Acta Anaesthesiol Scand 2011; 55: 778-784 doi:10.1111/j.1399-6576.2011.02429.x
    CrossrefPubMedGoogle Scholar
  • 29 Andersen LØ, Kehlet H. Analgesic efficacy of local infiltration analgesia in hip and knee arthroplasty: a systematic review. Br J Anaesth 2014; 113: 360-374 doi:10.1093/bja/aeu155
    CrossrefPubMedGoogle Scholar
  • 30 Affas F, Nygårds EB, Stiller CO. et al. Pain control after total knee arthroplasty: a randomized trial comparing local infiltration anesthesia and continuous femoral block. Acta Orthop 2011; 82: 441-447 doi:10.3109/17453674.2011.581264
    CrossrefPubMedGoogle Scholar
  • 31 Quinn M, Bowe A, Galvin R. et al. The use of postoperative suction drainage in total knee arthroplasty: a systematic review. Int Orthop 2015; 39: 653-658 doi:10.1007/s00264-014-2455-2
    CrossrefPubMedGoogle Scholar
  • 32 Yin D, Delisle J, Banica A. et al. Le garrot et le drain dans lʼarthroplastie totale du genou: pas dʼeffet favorable sur le saignement et la fonction du genou pour un coût accru. Revue de Chirurgie Orthopédique et Traumatologique 2017; 103: 397-403 doi:10.1016/j.rcot.2017.03.015
    CrossrefPubMedGoogle Scholar