Advertisement

Postoperative Probleme

  • Jörg Jerosch
Chapter

Zusammenfassung

Zur dauerhaften Sicherstellung des Erfolgs einer Knieendoprothese müssen gefährdende Komplikationen vermieden werden. Adäquate Wundversorgung, postoperative Analgesie, Verhütung einer tiefen Venenthrombose, postoperative Transfusionen und die Sicherung eines ausreichenden Bewegungsumfanges sind wichtige Fragen der Betreuung. Dieses Kapitel behandelt die Prävention von Komplikationen in der postoperativen Phase nach einem kniealloarthroplastischen Eingriff und die Probleme der postoperativen Schmerzkontrolle, des Blutverlustes und der Wundversorgung sowie Mobilisierungsprobleme. Allgemeines Ziel der postoperativen Behandlung eines Endoprothesenträgers ist es, Komplikationen weitgehend zu vermeiden und eine Rückkehr des Patienten zu einer allgemeinen Gesundheit mit der frühest- und bestmöglichen Funktion des ersetzten Kniegelenkes zu erreichen.

Literatur

  1. Abdelsalam A, Eyres KS (1995) Effects of tourniquet during total knee arthroplasty: a prospective randomised study. J Bone Joint Surg 77 B:250–253Google Scholar
  2. Alshryda S, Sarda P, Sukeik M, Nargol A, Blenkinsopp J, Mason JM (2011) Tranexamic acid in total knee replacement: a systematic review and meta-analysis. J Bone Joint Surg Br 93(12):1577–1585PubMedCrossRefGoogle Scholar
  3. Andersen KV, Pfeiffer-Jensen M, Haraldsted V, Soballe K (2007) Reduced hospital stay and consumption, and improved mobilization with local and intraarticular infiltration after hip arthroplasty. A randomized clinical trial of an intraarticular technique versus epidural infusions in 80 patients. Acta Orthopaedica 78(2):180–186Google Scholar
  4. Andersen KV, Bak M, Christensen BV et al (2010) A randomized, controlled trial vomparing local infltration analgesia with epidural infusion for total knee arthroplasty. Acta Orthopaedica 81:606–610PubMedCentralPubMedCrossRefGoogle Scholar
  5. Andersen LO, Husted H, Otte KS et al (2008) High-volume infiltration analgesia in total knee arthroplasty: a randomized, double-blind, placebo-controlled trial. Acta Anaesthesiol Scand 52:1331–1335PubMedCrossRefGoogle Scholar
  6. Andersen LO, Gaarn-Larsen L, Kristensen BB et al (2009) Subacute pain and function after fast-track hip and knee arthroplasty. Anaesthesia 64:508–513PubMedCrossRefGoogle Scholar
  7. Baur W, Hönle W, Willert HG, Schuh A (2005) Pathologische Veränderungen im umgebenden Gewebe von revidierten Metall-Metall-Gleitpaarungen. Orthopäde 34:225–233PubMedCrossRefGoogle Scholar
  8. Beer KJ, Lombardi AV, Mallory IH, Vaughn BK (1991) The efficiacy of suction drains after routine total joint arthroplasty. J Bone Joint Surg 73 A(584):587Google Scholar
  9. Behr WH, Doukas K (1991) Besteht bei präoperativen Eigenblutspenden vor allem bei herzchirurgischen Patienten ein erhöhtes Risiko für Nebenwirkungen und Komplikationen? Abstraktband zur 3. Informationstagung über Eigenbluttransfusion, 1990. Demeter, München, Mempel, Heim, S 13–15Google Scholar
  10. Behr WH, Lang H, Plahl M (1991) Präoperative Eigenblutspenden mit Flüssiglagerung von Erythrozytenkonzentraten mittels additiver Lösungen bei herzchirurgischen Patienten. Abstraktband zur 2. Informationstagung über Eigenbluttransfusion, 1989. Demeter, München, Mempel, Heim, S 8–12Google Scholar
  11. Berman AT, Geissele AE, Bosacco SJ (1988) Blood loss with total knee arthroplasty. Clin Orthop 234:137–138PubMedGoogle Scholar
  12. Berman AT, Parmet JL, Harding SP, Israelite CL, Chandrasekaran K, Howwow JC, Singer R, Rosenberg H (1988) Emboli observed with the use of transesophagal echo cardiography immediatly after tourniquet release during total knee arthoplasty with cement. J Bone Joint Surg 80-A:389–396Google Scholar
  13. Berman AT, Levenberg RJ, Tropiano MT, Parks B, Bosacco SJ (1996) Postoperative autotransfusion after total knee ar- throplasty. Orthopedics 19(1):15–22PubMedGoogle Scholar
  14. Bircher A, Friederich NF, Seelig W, Scherer K (2012) Allergic complications from orthopaedic joint implantas: the role of delayed hypersensitivity to benzoylperoxide in bone cement. Contact Dermatitis 66(1):20–6PubMedCrossRefGoogle Scholar
  15. Borelli S, Citronenbaum C, Düngemann H et al (1984) Metallallergien in der Chirurgie. Hefte Unfallheilkd 164:479–486Google Scholar
  16. Brown SA, Farnsworth LJ, Merritt K, Crowe TD (1977) Considerations of allergy and mechanics in the selection of orthopaedic implantat materials. Bull Hosp Joint Dis 38:67–68PubMedGoogle Scholar
  17. Busch CA, Shore BJ, Bhandari R et al (2006) Efficacy of periarticular multimodal drug injection in total kniee arthroplasty. A randomized trial. J Bone Joint Surg 88:959–963PubMedCrossRefGoogle Scholar
  18. Cancilleri F, De Giorgis P, Verdoia C et al (1992) Allergy to components of total hip arthroplasty before and after surgery. Ital J Orthop Traumatol 18:407–410PubMedGoogle Scholar
  19. Carli F, Clemente A, Asenjo JF et al (2010) Analgesia and functional outvome after total knee arthroplasty: periarticular infiltration vs. continuous femoral nerve block. Br J Anaesth 105:185–195PubMedCrossRefGoogle Scholar
  20. Coutts RD, Toth C, Kaita JN (1984) The role of continious passive motion in the rehabilitation of the total knee patient. In: Hungerford DS, Krackow KA, Kenna RV (Hrsg) Total knee arthroplasty: a comprehensive approach. Williams & Wilkins, Baltimore, S 128–132Google Scholar
  21. Cushner ED, Friedman RJ (1991) Blood loss in total knee arthroplasty. Clin Orthop 269:98–101PubMedGoogle Scholar
  22. Drinkwater CJ, Neil MJ (1995) Optimal timing of wound drain removal following total joint arthroplasty. J Arthroplasty 10(2):185–189PubMedCrossRefGoogle Scholar
  23. Düngemann H (1984) Allergiker als Problempatienten bei Operationen. Hefte Unfallchir 164:451–458Google Scholar
  24. Elves MW, Wilson JN, Scales JT, Kemp HB (1975) Incidence of metal sensitivity in patients with total joint replacements. Br Med J 15:376–378CrossRefGoogle Scholar
  25. Erpenbach J, Hofmeister E (2008) Hypersensitivity to polymethylmethacrylate following shoulder hemiarthroplasty. Orthopedics 31(7):708PubMedCrossRefGoogle Scholar
  26. Essving P, Axelsson K, Kjellberg J et al (2009) Reduced hospital stay, morphine consumption, and pain intensity woth local infiltration analgesia after unicompartmental knee arthroplasty. A randomized double-blind study of 40 patients. Acta Orthopaedica 80:213–219PubMedCentralPubMedCrossRefGoogle Scholar
  27. Essving P, Axelsson K, Kjellberg J et al (2010) Reduced morphine consumtion and pain intensity with local infiltration analgesia (LIA) following total knee arthroplasty. A randomized double-blind study involving 48 patients. Acta Orthopaedica 3(81):354–360CrossRefGoogle Scholar
  28. Fox JL, Poss R (1981) The role of manipulation following total knee replacement. J Bone Joint Surg 63 A:357–432Google Scholar
  29. Gannon DM, Lombardi AB, Mallory TH, Vaughn BK, Finney CR, Niemcryk S (1991) An evaluation of the efficiacy of post- operative blood salvage after total joint arthroplasty: a prospective randomized trial. J Arthroplasty 6(2):109–114PubMedCrossRefGoogle Scholar
  30. Gargaro JM, Walls CE (1991) Efficiacy of intraoperative autotransfusion in primary total hip arthroplasty. J Arthroplasty 6(2):157–162PubMedCrossRefGoogle Scholar
  31. Gebhart M, Geier J (1996) Evaluation of patch test results with denture material series. Contact Dermatitis 34(3):191–195PubMedCrossRefGoogle Scholar
  32. George DA, Sarraf KM, Nwaboku H (2014) Single perioperative dose of tranexamic acid in primary hip and knee arthroplasty. Eur J Orthop Surg Traumatol 23:Google Scholar
  33. Glück D, Kubanek B (1989) Transfusionsmedizin. Gustav Fischer, JenaGoogle Scholar
  34. Granchi D, Ciapetti G, Stea S et al (1995) Evaluation of several immunological parameters in patients with aseptic loosening of hip arthroplasty. Chir Organi Mov 80:399–408PubMedGoogle Scholar
  35. Haddad FS, Level NJ, Dowd PM, Cobb AG, Bentley G (1995) Cement hypersensitivity: a cause of aseptic loosening? The Journal of bone and joint surgery Britisch volume 77(2):329–330Google Scholar
  36. Hadden WA, McFarlane AG (1990) A comparative study of closed- wound suction drainage vs. no drainage in total hip arthroplasty. J Arthroplasty 5:S21–S24PubMedCrossRefGoogle Scholar
  37. Hallab N, Merritt K, Jakobs JJ (2001) Metal sensitivity in patients with orthopaedic implants. J Bone Joint Surg Am 83:428–436PubMedCrossRefGoogle Scholar
  38. Haughton AM, Belsito DV (2008) Acrylate allergy induced by acrylic nails resulting in prosthesis failure. J AM Acad Dermatol 59(5):123–124CrossRefGoogle Scholar
  39. Heiss MM, Mempel W, Delanoff CH, Mempel M, Jauch KW, Schildberg EW (1993) Multizentrische Studienplanung zur Immunmodulation bei Tumorpatienten durch die Bluttransfusion. In: Mempel W, Mempel M, Heim MU, Schwarzfischer G (Hrsg) Eigenbluttransfusion – eine aktuelle Obersicht. Sympomed. Sym pomed-Verlag, München, S 119–125Google Scholar
  40. Hoffmann J, Heisel J (1997aa) Effizienz einer stationären Anschlußheilbehandlung nach primärem endoprothetischen Knie- gelenkersatz. Orthop Praxis 33:173–178Google Scholar
  41. Hoffmann J, Heisel J (1997bb) Rehabilitationsergebnisse nach primärem endoprothetischen Kniegelenkersatz unter Einbeziehung poststationärer Ergebnisse ein Jahr nach Beendigung der AHB. Orthop Praxis 33:764–768Google Scholar
  42. Hofmann AA, Plaster RL, Murdock LE (1991aa) Subvastus (Sou- thern) approach for primary total knee arthroplasty. Clin Orthop 269:70–77PubMedGoogle Scholar
  43. Hofmann AA, Murdock LE, Wyatt RWB, Alpert JP (1991bb) Total knee arthroplasty. Two- to four-year experience using an asymmetric tibial tray and a deep trochlear-grooved fem- oral component. Orthop Clin 269:78–88Google Scholar
  44. Hönig JE, Merten HA, Engelke D, Luhr HG (1991) Die isovolämische Hämodilution als Alternative zur Eigenblutspende bei der operativen Behandlung von Bißanomalien. Abstraktband zur 2. Informationstagung über Eigenbluttransfusion, 1989. Demeter, München, Mempel Heim, S 26–30Google Scholar
  45. Jerosch J, Penner M, Castro WHM, Schmidt M (1994a) Fremdblutverbrauch und Möglichkeiten der autologen Hämotherapie am Beispiel der Hüft- und Knieendoprothetik. Z Orthop 132:459–465PubMedCrossRefGoogle Scholar
  46. Jerosch J, Schroder M, Steinbeck J, Halm H (1994bb) Arthroskopische Therapie der bakteriellen Arthritis. Arthroskopie 7:115–122Google Scholar
  47. Johnson DP (1990) The effect of continious passive motion on wound-healing and joint mobility after knee arthroplasty. J Bone Joint Surg 72 A:421–426Google Scholar
  48. Kerr DR, Kohan L (2008) Local infiltration analgesia: a technique fort he control of acute postoperative pain following knee and hip surgery. A case study of 325 patients. Acta Orthopaedica 79:174–183PubMedCrossRefGoogle Scholar
  49. Kettlekamp DB, Johnson RJ, Schmith GL, Chao EYS, Walker M (1970) An electrogoniometric study of knee motion in normal gait. J Bone joint Surg 52 A:775–790Google Scholar
  50. Krackow KA (1990) The technique of total knee arthroplasty. St. Louis, BaltimoreGoogle Scholar
  51. Lotke PA, Faralli VJ, Orenstein EM, Ecker ML (1991) Blood loss after total knee replacement. J Bone Joint Surg 73 A:1037–1040Google Scholar
  52. Maloney WJ, Schurmann DJ, Hangen D, Goodman SB, Edworthy S, Bloch DA (1990) The influence of continuous passive motion on outcome in total knee arthroplasty. Clin Orthop 256:162–168PubMedGoogle Scholar
  53. Marmor L (1990) Surgical technique of unicompartmental replacement. Tech Orthop 5:3–7CrossRefGoogle Scholar
  54. Messmer K (1979) Haemodilution. Surg Clin North Am 55:659Google Scholar
  55. Messmer K (1988) Haemodilution-possibilities and safety aspects. Acta Anaestiolol Scand 32(89):49–53CrossRefGoogle Scholar
  56. Milavec-Puretic V, Orlic D, Marusic A (1998) Sensitivity to metals in 40 patients with failed hip edoprosthesis. Arch Orthop Trauma Surg 117:383–386PubMedCrossRefGoogle Scholar
  57. Morin A, Wulf H (2011) Lokale Infiltrationsanästhesie für Hüft und Kniegelenksprothesen. Anästhesiol Intensivmed Notfallmed Schmerzther 46:84–86PubMedGoogle Scholar
  58. N I H (1988) Consensus Conference: Perioperative red cell trans- fusion. JAMA 260:2700–2703CrossRefGoogle Scholar
  59. Page MH, Shepherd BD, Harrison JM (1984) Reduction of blood loss in knee arthroplasty. Aust NZJ Surg 54:141CrossRefGoogle Scholar
  60. Parker et al (2004) Closed Suction Drainage for Hip and Knee Arthroplasty: A META-ANALYSIS. 86(6):1146–52 (Level 2 study)Google Scholar
  61. Parsley BS, Engh GA, Dwyer KA (1992) Preoperative flexion, does it influence postoperative flexion after posterior-cruciate retaining total knee arthroplasty. Clin Orthop 275:204–210PubMedGoogle Scholar
  62. Parvataneni HK, shah VP, Howard H et al (2007) Controlling pain after total hip and knee arthroplasty using a multimodal protocol whith local periarticualr injections. A prospective randomized study. J Arthroplasty 22(2):33–38PubMedCrossRefGoogle Scholar
  63. Patel JN, Spanyer JM, Smith LS, Huang J, Yakkanti MR, Malkani AL (2014) Comparison of Intravenous versus Topical Tranexamic Acid in Total Knee Arthroplasty. A Prospective Randomized Study. J Arthroplasty S0883-5403(14):00168-5 doi:10.1016/j.arth.2014.03.011Google Scholar
  64. Peters CL, Shirley B, Erickson J (2006) The effect of a new multimodal perioperative anesthetic regimen on postoperative pain, side effects, rehabilitation and lenght of hospital stay after total joint arthroplasty. J Arthroplasty 21(2):132–138PubMedCrossRefGoogle Scholar
  65. Poss R, Creasman CM, Pierson S, Kelly K, Batte N (1983) Comparison of ultimate flexion in manipulated and non-manipulated knee following total knee replacement. Orthop Trans 7:535Google Scholar
  66. Reilly TJ, Gradisar LA, Pakan W, Reilly M (1986) The use of post- operative suction drainage in total knee arthroplasty. Clin Orthop 208:238PubMedGoogle Scholar
  67. Reily KA, Beard DJ, Barker KL et al (2005) Efficacy of an accelerated recovery protocol for Oxford unicompartmental knee arthroplasty – a randomised controlled tiral. Knee 12:351–357CrossRefGoogle Scholar
  68. Ritter MA, Campbell ED (1987a) Effect of range of motion on the success of a total knee arthroplasty. J Arthroplasty 2(2):95–98PubMedCrossRefGoogle Scholar
  69. Ritter MA, Campbell ED (1987b) Postoperative patellar complications with or without lateral release during total knee arthroplasty. Clin Orthop 219:163–168PubMedGoogle Scholar
  70. Ritter MA, Stringer EA (1979) Predictive range of motion after total knee replacement. Clin Orthop 143:115–119PubMedGoogle Scholar
  71. Robins AJ, Kerina JM, Coutts RD (1993) Postoperative management and rehabilitation following total knee arthroplasty. In: Rand JA (Hrsg) Total knee arthroplasty. Raven Press, New York, S 423–434Google Scholar
  72. Rooker GD, Wilkinson JD (1980) Metal sensitivity in patients undergoing hip replacement. A prospective study. J Bone Joint Surg Br 62:502–505PubMedGoogle Scholar
  73. Rosenberg AG (1993) Surgical technique of posterior cruciate sacrificing and preserving total knee arthroplasty. In: Rand JA (Hrsg) Total knee arthroplasty. Raven Press, New York, S 115–154Google Scholar
  74. Röstlund T, Kehlet H (2007) High-dose local infiltration analgesia after hip and knee replacement – what is it, why does it work, and what are the future challenges? Guest editorial. Acta Orthopaedica 78:159–161PubMedCrossRefGoogle Scholar
  75. Rostocker G, Robin J, Binet O et al (1987) Dermatitis due to orthopaedic implants. A review of the literature and report of three cases. J Bone Joint Surg Am 69:1408–1412Google Scholar
  76. Schleinzer H-H, Mehrkens H, Weidler M, Fricke M (1988) Möglichkeiten zur Vermeidung der potentiellen Transfusionsrisiken bei größeren orthopädischen Operationen durch konsequente Nutzung von autologem Blut und Plasmaersatz. Klin Wochenschr 66(15):15–22Google Scholar
  77. von Schroder HP, Coutts RP, Billings E, Mai MT, Aratow M (1991) The changes in intramuscular pressure and femoral vein flow with continuous passive motion, pneumatic compressive stockings and leg manipulation. Clin Orthop 266:218–226Google Scholar
  78. Schurmann DJ, Parker JN, Orstein D (1985aa) Total condylar knee replacement: a study of factors influencing range of motion as late as two years after arthroplasty. J Bone Joint Surg 67 A:1006–1014Google Scholar
  79. Schurmann DJ, Parker JN, Orstein D (1985bb) Total condylar knee replacement: a study of factors influencing range of motion as late as two years after arthroplasty. J Bone Joint Surg 67 A:1006–1014Google Scholar
  80. Scott RD, Siliski SM (1985) The use of a modified V-Y quadricepsplasty during total knee replacement to gain exposure and improve flexion in the ankylosed knee. Orthopedics 8:445–458Google Scholar
  81. Scott RD, Joyce MJ, Ewald EC, Thomas WH (1985) McKeever metallic hemiarthroplasty of the knee in unicompartmental degenerative arthritis; long term clinical follow-up and current indications. J Bone Joint Surg 67 A:203–205Google Scholar
  82. Semkiw LB, Schurmann DJ, Goodman SB, Woolson ST (1989) Postoperative blood salvage using the cell saver after total joint arthroplasty. J Bone Joint Surg 71 A:823–827Google Scholar
  83. Sibrowski W, Penner M, Kuhnl P (1993) Transfusionsbedingte Virusinfektion - Wie groß ist das Restrisiko. Infusionsther 20, (Suppl.2):4–9Google Scholar
  84. Singelbarth G, Schleinzer W (1991) Das Konzept der autologen Transfusion. Abstraktband zur 3. Informationstagung über Eigenbluttransfusion, 1990. Demeter, München, S 120–122Google Scholar
  85. Spreng UJ, Dahl V, Hjall A et al (2010) High-volume local infiltration analgesia combined with intravenous or local ketorola+morphine compared with epidural analgesia after total knee arthroplasty. Br J Anaesth 105:675–682PubMedCrossRefGoogle Scholar
  86. Tew M, Forster JW, Wallace WA (1989) Effect of total knee arthroplasty on maximal flexion. Clin Orthop 247:168–174PubMedGoogle Scholar
  87. Thomas P (2003) Allergien durch Implantatwerkstoffe. Orthopäde 32:60–64PubMedCrossRefGoogle Scholar
  88. Thomas P, Schuh A, Eben R, Thomsen M (2008) Allergie auf Knochenzementbestandteile. Orthopäde 37(2):117–20PubMedCrossRefGoogle Scholar
  89. Thomas P, Stauner K, Schraml A, Mahler V, Banke IJ, Gollwitzer H, Burgkart R, Prodinger PM, Schneider S, Pritschet M, Mazoochian F, Shopf C, Steinmann A, Summer B (2013) Charakteristika von 200 Patienten mit Verdacht auf Implantatallergie im Vergleich zu 100 beschwerdefreien Endoprothesenträgern. Orthopäde 42(8):607–613PubMedCrossRefGoogle Scholar
  90. Toftdahl K, Nikolajsen L, Haraldsted V et al (2007) Comparison of peri- and intraarticular analgesia with femoral nerve block after total knee arthroplasty. A randomized controlled trial. Acta Orthopaedica 78:172–179PubMedCrossRefGoogle Scholar
  91. Ulrich HW, Rogge MM (1992) Nachbehandlung nach Implantation der Blauth-Knieprothese. In: Hassenpflug J (Hrsg) Die Blauth-Knieendoprothese. Grundlagen, gegenwärtiger Stand und Ausblick. Hans Huber, Bern Göttingen Toronto Seattle, S 119–122Google Scholar
  92. Veikkolin T, Korkala O, Niskanen R, Liesjarvi S (1995) Autotransfusion of drained blood after total knee arthroplasty. Annales Chirurgiae et Gynaecologiae 84(3):281–284PubMedGoogle Scholar
  93. Vendittoli PA, Makinen P, Lavigne M et al (2006) A multimodal analgesia protocol for total knee arthroplasty. A randomized, controlled study. J Bone Joint Surg 88:282–289PubMedCrossRefGoogle Scholar
  94. Walker PS, Garg A (1991) Range of motion in total knee arthroplasty. Clin Orthop 262:227–235PubMedGoogle Scholar
  95. Walker RH, Morris BA, Angulo DL, Schneider J, Colwell CW (1991) Postoperative use of continuous passive motion. Transcutaneus electrical nerve stimulation and continuous cooling pad following total knee arthroplasty. I Arthroplasty 6(2):151–156CrossRefGoogle Scholar
  96. Whiteside LA, Ohl MD (1990) Tibial tubercle osteotomy for exposure of the difficult total knee arthroplasty. Clin Orthop 260:6–9PubMedGoogle Scholar
  97. Willemen D, Paul J, White SH, Crock DVM (1991) Closed suction drainage following knee arthroplasty. Clin Orthop 264:232–234PubMedGoogle Scholar
  98. Woolsen ST, Watt M (1991) Use of autologous blood in total hip replacement: a comprehensive program. J Bone Joint Surg 73 A:76–80Google Scholar
  99. Youn-Soo P, Young-Wan M, Seung-Jae L et al (2005) Early osteolysis following second-generation metal-on-metal hip replacement. J Bone Joint Surg Am 87:1515–1521CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Jörg Jerosch
    • 1
  1. 1.Klinik für Orthopädie und UnfallchirurgieJohanna-Etienne-HospitalNeussDeutschland

Personalised recommendations