[Risk management in orthopedic surgery : Stratification and adjustment of patient-individual risk factors]

Influence of parkinson's disease on complications and revisions in total hip and knee arthroplasty: insights from a matched pair analysis

PURPOSE

The outcome of elective total joint arthroplasty (TJA) in patients with Parkinson's disease (PD) is controversial due to the concomitant risk profile. This study investigated postoperative complications and revision rates following total hip (THA) and knee arthroplasty (TKA) in patients with PD.

METHODS

Ninety-six patients with PD undergoing THA or TKA were matched 1:1 with non-PD patients using propensity score matching for age, sex and comorbidity (Charlson Comorbidity index, CCI). Rates of revisions, medical and surgical complications were compared. Univariate and multivariate regression analyses were calculated.

RESULTS

PD patients exhibited higher rates of revision-surgeries within 90 days (13.5% vs. 5.2%; p = 0.048), medical complications (68.8% vs. 43.8%; p < 0.001) and surgical complications (40.6% vs. 21.9%; p = 0.005). Multivariate regression analysis confirmed PD as a significant risk factor for complications and long-term revision-surgeries.

CONCLUSION

PD increases the risk of adverse outcomes following THA and TKA. Improvements in pre-operative planning and post-operative care are critical to the improvement of outcomes in this vulnerable population.

[Risk and complication profiles of orthogeriatric patients in elective hip and knee joint replacement]

BACKGROUND

The care of geriatric patients undergoing elective orthopedic surgery is becoming increasingly more important due to demographic trends. Compared to geriatric traumatology, however, there are still no established orthogeriatric care models in Germany and therefore hardly any scientific data. The aim of this study was to describe the risk and complication profiles in older patients with elective hip and knee replacements.

METHODS

In a prospective study data were collected from orthogeriatric patients with indications for elective hip and knee replacement surgery who fulfilled defined inclusion and exclusion criteria between January 2021 and August 2023 in the orthopedic department of a German university hospital for the descriptive analysis of risk and complication profiles. In addition to a preoperative and perioperative data analysis, a follow-up was conducted 4-6 weeks and 3 months postoperatively.

RESULTS

The surgical risk profile of the patient population analyzed was characterized by advanced age (78.4 ± 4.8 years), preobesity/obesity (76%), multimorbidity (7.4 ± 3.1 comorbidities), polypharmacy (7.5 ± 3.8 medications), immobility (short physical performance battery 7.1 ± 2.6), prefrailty/frailty (87%), frequent anticoagulation (22%) and a high number of potentially inappropriate medications (64%). Complication events mainly occurred within the first 7 days postoperatively and 90% of the events within this recording period were minor complications. The overall complication rate significantly decreased in the follow-up period.

CONCLUSION

Due to the high risk and complication profiles the routine use of orthogeriatric co-management models for elective orthopedic surgery should be considered in the future.

[SOG-Special Orthopedic Geriatrics : First interim results of a randomized controlled study on integrated orthogeriatric care in elective hip and knee arthroplasty]

BACKGROUND

To date, there are no adequate care concepts for geriatric patients undergoing elective orthopaedic surgery in Germany. The Special Orthopaedic Geriatrics (SOG) study evaluates for the first time in Germany the impact of comprehensive orthogeriatric co-management on the outcome of elderly patients with elective hip and knee replacements compared to standard orthopaedic care.

METHODS

The interim analysis of the ongoing study included 174 patients; 87 patients were randomized to the intervention group and 87 to the control group. The SOG care model consists of screening, preoperative assessment with preoperative intervention, fast-track surgery and multimodal perioperative care in the orthogeriatric team. The control group received standard orthopaedic care. Mobility, complications, and patient-reported outcome measures after surgery were compared.

RESULTS

The SOG group showed a clinically relevant improvement in mobility postoperatively compared to the control group at all time points (p < 0.01). The evaluation of complications showed a significant risk reduction for minor complications (p < 0.01), as well as a clear trend towards a risk reduction for major complications. Patient-reported outcome measures showed a significant improvement in joint function and general health-related quality of life both in the SOG group and the control group.

CONCLUSION

Integrated orthogeriatric care models such as SOG could improve the care of geriatric patients in elective orthopaedic surgery in the future and, above all, make it safer.

[Preoperative screening for risk factors]

The demographic change and continuously improving healthcare lead to increasing numbers of older, comorbid patients in elective orthopedic surgery. Perioperative risk assessment is crucial for patient counseling and preoperative planning. Risk factors, such as heart failure, chronic obstructive pulmonary disease, peripheral arterial occlusive disease, anemia, malnutrition, obesity, smoking and insufficiently controlled diabetes mellitus are common in patients undergoing elective orthopedic surgery. A thorough and early screening not only enables the individual assessment of the risk profile but in an elective setting also enables the chance for modification of certain risk factors in order to reduce the individual perioperative risk. Meanwhile, recommendations regarding risk stratification and adjustment of modifiable risk factors are included in national guidelines on the indications for elective total hip arthroplasty.