| Popis: |
Approximately half of all hospitals in Germany perform primary hip and knee arthroplasty. Symptomatic osteoarthritis is the cause of 80 % of primary hip replacements and 96 % of primary knee replacements. In accordance with mandatory external quality assurance measures for hospitals, an increase in the documentation of appropriate indications has been observed for a growing proportion of patients over the last few years and reached 96 % for both types of surgery in 2014. A limiting factor, however, is that some of the relevant indication criteria do not yet exist in a standardized or evidence-based format. Hip and knee replacements are amongst the most commonly performed inpatient procedures. Patients who undergo primary hip or knee replacement account for approximately 2 % of all full-time inpatients. Over the past years, the length of hospital stay for arthroplasty patients has been declining continuously with a greater decline relative to the average length of stay for all other types of hospital treatments. In 2014, the average length of stay was approximately 11.8 days and 10.6 days for total hip and for total knee arthroplasty respectively. Surgical complications during inpatient stays for primary arthroplasty have been declining for years and are now in the lower single-digit percentage range. Routine statutory health insurance data between 2005 and 2006 show that that 3.5 % of primary hip arthroplasty patients and 3.8 % of primary knee arthroplasty patients underwent premature revision total replacement within the first 2 years after surgery. The risk of complications from endoprosthetic surgery depends on numerous factors. Influencing factors include the implant itself and the type surgery performed (including the surgeon's experience, surgical techniques, the duration of surgery, etc.), the patient's medical characteristics (concomitant diseases, compliance, etc.) as well as the type of rehabilitation care and ambulatory follow-up care. To date, no relevant data on service lives and influencing factors have been systematically collected in Germany. However, this is expected to change thanks to the German arthroplasty registry »Endoprothesenregister Deutschland« which was established in 2011. Rehabilitation treatment should start soon after surgery and in the majority of cases this is commenced a few days after discharge from hospital. However, due to shorter lengths of hospital stays, patients in rehabilitation clinics have greater care requirements. Older multimorbid patients in particular, require targeted geriatric, interdisciplinary care. Surveys carried out on statutory health insurees have indicated that most patients show a significant reduction in symptoms after surgery and that this is still the case even 5 years after surgery. In addition, a large majority of patients are satisfied with the procedure. These effects are more pronounced in hip surgery patients than in patients who have undergone knee replacements. The vast majority of patients return to work following the procedure. |
