Die Sicherstellung einer hochwertigen medizinischen Versorgung in Deutschland ist durch aktuelle und prognostizierte demografische Entwicklungen gefährdet.

Background. Arthroplasty is an effective treatment for end-stage osteoarthritis of the knee and is one of Germany's most frequently performed orthopedic procedures. Discussion. However, a considerable number of patient are not satisfied with the results after knee arthroplasty. The patient's perspective is particularly important for shared decision making. "Patient satisfaction" with the surgery is an expression of the patient's perspective, but might not be sufficient as the only outcome measure. There is no international consensus which outcome measures should be used after knee arthroplasty. Conclusion. Therefore, different measurement tools are used for the acquisition of a variety of outcome measures in order to quantify the results of knee arthroplasty. These tools should be used according to their reliability, validity, and responsiveness. This article provides an overview about available measurement tools.

Purpose: To investigate response rates and predictors of treatment success in patients treated with total hip arthroplasty (THA).Methods: A prospective register-based cohort study including all consecutive primary THAs was conducted between 01/2006-12/2011. Primary outcomes were changes in WOMAC, according to OMERACT-OARSI, and minimal important difference (MID) in quality of life (EQ-5D) between baseline and 6-month follow-up. Socioeconomic and clinical predictors on treatment success were analysed by bivariate/multivariate regression.Results: The study population included 2,553 patients (mean age 60.8 years; 52.8% female) and 2,391 (93.7%) at follow-up. 2,194 (93.8%) (OMERACT-OARSI) and 2,131 (83.5%) (EQ-5D MID) patients were classified as responders. Predictors for treatment success vs treatment failure were not identified. Obese patients and patients living alone showed less pronounced, and patients with higher educational level more pronounced, improvements in the WOMAC at follow-up.Conclusions: Treatment with THA leads to improvement in function, decline in pain and increase in quality of life in the vast majority of patients.

Concomitant disorders at the time of surgery in addition to psychological and socioeconomic patient characteristics may influence treatment outcomes in hip arthroplasty. To describe the impact of these factors on perioperative complications and postoperative results in terms of function, quality of life, and patient satisfaction . Review of relevant clinical studies, meta-analyses, and presentation of our own results . Comorbidities in general, especially in combination, increase the perioperative risk profile. Socioeconomic factors (education, professional qualifications, social deprivation) in addition to psychological variables (depression, distressed personality) can have a major impact on postoperative functional outcomes and patient satisfaction. It is of crucial importance to avoid inequalities in the provision of joint replacement for patients with hip osteoarthritis and co-existing risk factors. Preventive strategies should be implemented to reduce the negative impact of comorbidities on treatment outcome. Personalized communication and education may be helpful in avoiding unrealistic patient expectations before hip replacement.

Der Behandlungserfolg in der Hüftendoprothetik wird von vielen unterschiedlichen Faktoren beeinflusst. Dazu gehören auch zum Zeitpunkt der Operation bestehende Begleiterkrankungen, die Persönlichkeit des Patienten und die sozioökonomischen Rahmenbedingungen.

Die endoprothetische Versorgung bei fortgeschrittener Gonarthrose ist eine weltweit durchgeführte und effektive Methode zur Verbesserung von Schmerz und Funktion und ist in Deutschland einer der häufigsten Routineeingriffe in der Orthopädie und Unfallchirurgie.

Background: Joint replacement surgery is one of the most often performed routine procedures for the treatment of knee osteoarthritis in Germany. Currently, there is no consensus on indication criteria for total knee arthroplasty (TKA).Objectives: The topic indication for TKA was processed using six guiding questions concerning: 1) Common practice in determining the indication for TKA; 2) Inclusion criteria in clinical trials; 3) Treatment goals/goal criteria; 4) Predictors for goal attainment; 5) Economic aspects of determining a TKA indication; 6) Guidelines of the "Working Group of Scientific Medical Societies" (AWMF) in other areas.Methods: The evidence mapping was conducted by systematically searching Medline via Ovid, the Cochrane Library, through hand searching national guidelines and selected journals as well as the AWMF guideline portal.Results of the guiding questions: 1) In Germany there is currently no consented guideline regarding indications for TKA surgery. 2) Indication criteria for clinical trials are: diagnosed osteoarthritis of the knee, limitations of age and BMI. The most common criteria for exclusion include rheumatoid/inflammatory arthritis, secondary diagnoses and allergies. 3) As yet, no international initiatives have been identified which, by involving all relevant stakeholders, have reached consensus regarding the indication criteria for TKA. 4) A variety of predictors were identified with effects on individual treatment goals acting in different directions. 5) Very few studies were identified concerning economic aspects of determining TKA indication. 6) Comparable AWMF guidelines are currently not available.Conclusion: The findings of this study suggest that specific systematic reviews are needed to explore the following questions: What are the treatment goals of a TKA intervention? For whom are these relevant? And how are they measured? Continuous analyses are recommended in the field of predictors for a positive TKA outcome.

Hintergrund: Die Versorgung mittels Totalendoprothetik (TEP) bei Hüftgelenksarthrose zählt zu den häufigsten orthopädischen Eingriffen. Aktuelle Fragestellungen der Versorgungsforschung betreffen den Einfluss von TEP auf patientenrelevante Outcomes wie Lebensqualität, Schmerzen und körperliche Belastbarkeit sowie Prädiktoren für Therapieerfolg.