[Perioperative management of ortho-geriatric knee or hip arthroplasty patients]

[Strategies for cup revision]

Hip arthroplasty revision management can range from simple procedures using standard implants to complex surgical interventions requiring the combined use of revision cups, metal augments, bone grafts, and antiprotrusio cages. The adequate restoration of biomechanics and function of the hip joint with reconstruction of the original center of rotation can be challenging. We present an overview of various available techniques with the associated implant and anchoring strategies and the respective clinical results depending on the acetabular defect situation.

[Day-case outpatient endoprosthetics-"Ultra-Fast-Track"]

Fast-track procedures are common in general surgery today. In our European neighbour countries and in the USA, one-day-surgery for knee and hip replacement is gaining popularity. However, it is of great importance that a detailed concept for prehabilitation with a sufficient training program and targeted instructions regarding behavioral measures are established to allow a safe outpatient procedure. Where fast-track programs are established, one-day surgery with minimally invasive operative procedures for hip and knee arthroplasty is the consequent next step.

[Perioperative management in fast-track arthroplasty]

The optimization of organizational processes, as well as surgical procedures intra- and perioperatively, are essential components with respect to fast-track programs in clinical routine. Treatment concepts focus on early postoperative mobilization of patients after joint replacement surgery in an interdisciplinary setting to avoid pain and complications on a scientific basis. This article gives a comprehensive and detailed overview regarding evidence-based peri- and intraoperative fast-track treatment methods: from pain treatment with intraoperative local infiltration analgesia and tranexamic acid application under minimally invasive surgical approach in short-lasting spinal anesthesia to renunciation of drains, regional pain- and urinary catheters, tourniquets, and restrictions.