Klaus-Peter Günther1, Stefanie Deckert, Cornelia Lützner, Toni Lange, Jochen Schmitt, Anne Postler. 1. University Center of Orthopaedics, Traumatology & Plastic Surgery, University Medicine Carl Gustav Carus Dresden, Germany; Center for Evidence-Based Healthcare, University Medicine Carl Gustav Carus Dresden and the Medical Faculty Carl Gustav Carus of the Technical University Dresden.
Abstract
BACKGROUND: Total Hip Replacement (THR) belongs to the most common inpatient operations in Germany, with over 240 000 procedures performed per year. 90% of the artificial joints are still functional at 15 years, and up to 60% at 20 years after surgery. It is essential that the indications for such procedures should be uniform, appropriate, and patient-oriented. METHODS: This review is based on publications retrieved by a systematic literature search for national and international guidelines and systematic reviews on the topic of hip osteoarthritis and THR. RESULTS: THR should be performed solely with radiologically demonstrated advanced osteoarthritis of the hip (Kellgren and Lawrence grade 3 or 4), after at least three months of conservative treatment, and in the presence of high subjective distress due to symptoms arising from the affected hip joint. Contraindications include refractory infection, acute or chronic accompanying illnesses, and BMI ≥= 40 kg/m2. Patients should stop smoking at least one month before surgery. In patients with diabetes mellitus, preoperative glycemic control to an HbA1c value below 8% is advisable. It is recommended that patients should lower their weight below a BMI of 30 kg/m2. CONCLUSION: The decision to perform THR should be taken together by both the physician and the patient when the expected treatment benefit outweighs the risks. Evidence suggests that a worse preoperative condition is associated with a poorer surgical outcome.
BACKGROUND: Total Hip Replacement (THR) belongs to the most common inpatient operations in Germany, with over 240 000 procedures performed per year. 90% of the artificial joints are still functional at 15 years, and up to 60% at 20 years after surgery. It is essential that the indications for such procedures should be uniform, appropriate, and patient-oriented. METHODS: This review is based on publications retrieved by a systematic literature search for national and international guidelines and systematic reviews on the topic of hip osteoarthritis and THR. RESULTS: THR should be performed solely with radiologically demonstrated advanced osteoarthritis of the hip (Kellgren and Lawrence grade 3 or 4), after at least three months of conservative treatment, and in the presence of high subjective distress due to symptoms arising from the affected hip joint. Contraindications include refractory infection, acute or chronic accompanying illnesses, and BMI ≥= 40 kg/m2. Patients should stop smoking at least one month before surgery. In patients with diabetes mellitus, preoperative glycemic control to an HbA1c value below 8% is advisable. It is recommended that patients should lower their weight below a BMI of 30 kg/m2. CONCLUSION: The decision to perform THR should be taken together by both the physician and the patient when the expected treatment benefit outweighs the risks. Evidence suggests that a worse preoperative condition is associated with a poorer surgical outcome.
Authors: K-P Günther; E Haase; T Lange; C Kopkow; J Schmitt; C Jeszenszky; F Balck; J Lützner; A Hartmann; M Lippmann Journal: Orthopade Date: 2015-07 Impact factor: 1.087
Authors: R R Bannuru; M C Osani; E E Vaysbrot; N K Arden; K Bennell; S M A Bierma-Zeinstra; V B Kraus; L S Lohmander; J H Abbott; M Bhandari; F J Blanco; R Espinosa; I K Haugen; J Lin; L A Mandl; E Moilanen; N Nakamura; L Snyder-Mackler; T Trojian; M Underwood; T E McAlindon Journal: Osteoarthritis Cartilage Date: 2019-07-03 Impact factor: 6.576
Authors: Jeffrey J Cherian; Julio J Jauregui; Samik Banerjee; Todd Pierce; Michael A Mont Journal: Clin Orthop Relat Res Date: 2015-02-26 Impact factor: 4.176
Authors: V M A Voorn; A van der Hout; C So-Osman; T P M Vliet Vlieland; R G H H Nelissen; M E van den Akker-van Marle; A Dahan; P J Marang-van de Mheen; L van Bodegom-Vos Journal: Vox Sang Date: 2016-06-17 Impact factor: 2.144
Authors: Beverley J Shea; Barnaby C Reeves; George Wells; Micere Thuku; Candyce Hamel; Julian Moran; David Moher; Peter Tugwell; Vivian Welch; Elizabeth Kristjansson; David A Henry Journal: BMJ Date: 2017-09-21