以证据为基础、以患者为中心的膝关节置换术适应症--指南更新。

Jörg Lützner, Stefanie Deckert, Toni Lange, Anne Elisabeth Postler, Martin Aringer, Hendrik Berth, Hartmut Bork, Karsten E Dreinhöfer, Klaus-Peter Günther, Karl-Dieter Heller, Robert Hube, Stephan Kirschner, Bernd Kladny, Christian Kopkow, Rainer Sabatowski, Johannes Stoeve, Richard Wagner, Cornelia Lützner
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引用次数: 0

摘要

膝关节置换术是德国最常见的手术之一,每年约有 17 万例手术。因此,医生必须遵守适当的、以患者为中心的适应症程序。更新后的膝关节置换术(EKIT-Knee)适应症指南标准包含了基于当前证据并经广泛共识小组同意的建议。为便于实际使用,还对检查表进行了更新。为更新该指南,我们进行了一项系统性文献研究,以分析(国家间)指南和系统性综述,重点关注膝关节骨性关节炎和膝关节置换术,回答诊断、结果预测、风险因素和禁忌症等临床相关问题。膝关节置换术仅适用于经放射学证实患有中度或重度膝关节骨性关节炎(Kellgren-Lawrence 3 级或 4 级)、既往接受过至少三个月的非手术治疗、主观膝关节相关主诉负担较重且排除了可能的禁忌症(感染、合并症、体重指数≥ 40 kg/m2)的患者。可改变的风险因素(如吸烟、糖尿病、贫血)应提前解决并优化。在满足当前指南的适应症后,建议患者和外科医生共同决策,以保持对膝关节骨性关节炎患者进行高质量的手术治疗。S2k指南的更新版扩大了单髁膝关节置换术的范围,增加了对可改变风险因素的术前优化,并明确了主要适应症标准。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Evidence-based and Patient-centered Indication for Knee Arthroplasty - Update of the Guideline.

Knee arthroplasty is one of the most frequently performed operations in Germany, with approximately 170000 procedures per year. It is therefore essential that physicians should adhere to an appropriate, and patient-centered indication process. The updated guideline indication criteria for knee arthroplasty (EKIT-Knee) contain recommendations, which are based on current evidence and agreed upon by a broad consensus panel. For practical use, the checklist has also been updated.For this guideline update, a systematic literature research was conducted in order to analyse (inter-)national guidelines and systematic reviews focusing on osteoarthritis of the knee and knee arthroplasty, to answer clinically relevant questions on diagnostic, predictors of outcome, risk factors and contraindications.Knee arthroplasty should solely be performed in patients with radiologically proven moderate or severe osteoarthritis of the knee (Kellgren-Lawrence grade 3 or 4), after previous non-surgical treatment for at least three months, in patients with high subjective burden with regard to knee-related complaints and after exclusion of possible contraindications (infection, comorbidities, BMI ≥ 40 kg/m2). Modifiable risk factors (such as smoking, diabetes mellitus, anaemia) should be addressed and optimised in advance. After meeting current guideline indications, a shared decision-making process between patients and surgeons is recommended, in order to maintain high quality surgical management of patients with osteoarthritis of the knee.The update of the S2k-guideline was expanded to include unicondylar knee arthroplasty, the preoperative optimisation of modifiable risk factors was added and the main indication criteria were specified.

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