When are patients with osteoarthritis referred for surgery?

IF 4.5 2区医学 Q1 RHEUMATOLOGY

Best Practice & Research in Clinical Rheumatology Pub Date : 2023-06-01 DOI:10.1016/j.berh.2023.101835

A.E. Postler , C. Lützner , J. Goronzy , T. Lange , S. Deckert , K.P. Günther , J. Lützner

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引用次数: 0

Abstract

Current treatment strategies in hip and knee osteoarthritis (OA) involve a combined approach that includes not only modification of risk factors and conservative treatment but also joint-preserving surgical therapy in the early stages, or joint replacement in late OA. With the recent development of new etiological concepts (i.e. hip dysplasia and femoroacetabular impingement as major risk factors for hip OA), treatment alternatives for joint preservation could be extended significantly. Satisfactory results of osteotomies and other reconstructive procedures around hip and knee joints can only be expected in early OA (Kellgren/Lawrence grade 0-II). If patients with advanced radiographic OA grades III-IV do not respond to conservative treatment over at least 3 months and express a relevant burden of disease, joint replacement might be considered. Prior to surgery, potential contraindications must be excluded, patient expectations need to be discussed, and modifiable risk factors, which may negatively influence the outcome, should be optimized.

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骨关节炎患者何时转诊接受手术治疗？

目前的髋关节和膝关节骨性关节炎（OA）治疗策略涉及一种综合方法，不仅包括改变风险因素和保守治疗，还包括早期阶段的关节保护手术疗法，或晚期 OA 的关节置换术。随着近来新病因概念的发展（即髋关节发育不良和股骨髋臼撞击是髋关节 OA 的主要风险因素），保留关节的治疗方法可大大扩展。只有在早期 OA（Kellgren/Lawrence 分级 0-II）时，髋关节和膝关节周围的截骨手术和其他重建手术才能取得令人满意的效果。如果晚期 OA 患者的影像学分级为 III-IV 级，且对至少 3 个月的保守治疗无反应，并表现出相关的疾病负担，则可考虑进行关节置换术。手术前必须排除潜在的禁忌症，讨论患者的期望，并优化可能对手术效果产生负面影响的可改变风险因素。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Best Practice & Research in Clinical Rheumatology 医学-风湿病学

CiteScore

9.40

自引率

0.00%

发文量

审稿时长

27 days

期刊介绍： Evidence-based updates of best clinical practice across the spectrum of musculoskeletal conditions. Best Practice & Research: Clinical Rheumatology keeps the clinician or trainee informed of the latest developments and current recommended practice in the rapidly advancing fields of musculoskeletal conditions and science. The series provides a continuous update of current clinical practice. It is a topical serial publication that covers the spectrum of musculoskeletal conditions in a 4-year cycle. Each topic-based issue contains around 200 pages of practical, evidence-based review articles, which integrate the results from the latest original research with current clinical practice and thinking to provide a continuous update. Each issue follows a problem-orientated approach that focuses on the key questions to be addressed, clearly defining what is known and not known. The review articles seek to address the clinical issues of diagnosis, treatment and patient management. Management is described in practical terms so that it can be applied to the individual patient. The serial is aimed at the physician in both practice and training.