DARWIN Digitale Dissertationen German Version Strich

FU Berlin
Digitale Dissertation

Alexander Hilss :
Results of early rehabilitation in total knee arthroplasty with an epidural catheter
Ergebnisse in der Frührehabilitation nach endoprothetischem Kniegelenksersatz mit Periduralkatheter

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Abstract

Aim: The aim of this study was to examine the benefit of perioperative epidural anaesthesia in total knee arthroplasty. Is there a better early rehabilitation outcame and on the other side does it have a negative influence on the complication rate and the perioperative blood loss? Method: The study was randomised and prospectively conducted. 39 patient got an epidural catheter for the operation with was reactivated with a single shot injection on the day after the operation. Therefore a painless passive mobilisation of the operated kneewas possible untill 120 degrees of flection. The 17 patients of the control group underwent the operation in general anaesthesia with conventionel parenteral postoperative analgesia. Each patient was examined with the help of a standardized examination protocol on day before the operation and after one, two and sixteen weeks. Results: There was a significantly better flection with peridural catheter postoperativ after one and two weeks. Also significantly better was the walking range after one and sixteen weeks after the operation. There was no significant difference in the score of Lysholm and Gillquist. There was an increased rate of complications in the study group, first of all cases of delayed wound healing. Conclusion: The usage of the epidural catheter is an option to consider in perioperative knee arthroplasty. However the increased rate of complications is a concern.

Table of Contents

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0             TITELBLATT UND INHALTSVERZEICHNIS                      

VERWENDETE ABKÜRZUNGEN                                                                             

1             EINLEITUNG                                                                                                 

1.1          Anatomie und Biomechanik des Kniegelenkes                                                     

1.2          Die Gonarthrose                                                                                                 

1.2.1       Epidemiologie                                                                                                     

1.2.2       Ätiologie                                                                                                             

1.2.3       Pathophysiologie                                                                                                 

1.2.4       Klinik                                                                                                                 

1.2.5       Stadieneinteilung                                                                                                 

1.2.6       Diagnose                                                                                                            

1.2.7       Therapie                                                                                                             

1.3          Die rheumatoide Arthritis                                                                                    

1.3.1       Definition                                                                                                            

1.3.2       Ätiopathogenese                                                                                                 

1.3.3       Klinik                                                                                                                 

1.3.4       Diagnose                                                                                                            

1.3.5       Therapie                                                                                                             

1.4          Endoprothetik des Kniegelenkes                                                                         

1.4.1       Grundlagen der Kniegelenkendoprothetik                                                            

1.4.2       Indikation und Kontraindikation                                                                          

1.4.3       Werkstoffe                                                                                                         

1.4.4       Prothesenverankerung                                                                                         

1.4.5       Retropatellarer Gleitflächenersatz                                                                        

1.4.6       Komplikationen                                                                                                  

1.5                    Peri- und postoperative Anästhesie und Analgesie mit periduralem

               Verweilkatheter                                                                                                  

1.5.1       Anatomische Grundlagen und Anlage des Katheters                                            

1.5.2       Periduralanästhesie und -analgesie mit Lokalanästhetika                                      

1.5.3       Periduralanästhesie und -analgesie mit Opiaten                                                    

1.5.4       Kombination von periduralen Opiaten und Lokalanästhetika                                

2             FRAGESTELLUNG                                                                                        

3             MATERIAL UND METHODEN                                                                  

3.1          Charakteristik des Patientenkollektivs                                                                  

3.1.1       Aufnahmekriterien der Studie                                                                              

3.1.2       Indikationen zur Operation                                                                                  

3.1.3       Verteilung nach Geschlechtern                                                                             

3.1.4       Altersverteilung                                                                                                   

3.2          Die verwendeten Prothesenmodelle und deren Differentialindikation                     

3.3          Durchführung der Studie                                                                                     

3.4          Untersuchung der Patienten                                                                                 

3.5          Der Operationsablauf                                                                                          

3.6          Der Postoperative Verlauf                                                                                   

3.7          Statistische Auswertung und Darstellung der Ergebnisse                                       

4             ERGEBNISSE                                                                                        

4.1          Der Score nach Lysholm/Gillquist                                                                        

4.1.1       Ergebnisse des Gesamtscores                                                                             

4.1.2       Ergebnisse des Teilscores Hinken                                                                        

4.1.3       Ergebnisse des Teilscores Gehhilfen                                                                    

4.1.4       Ergebnisse des Teilscores Treppensteigen                                                           

4.1.5       Ergebnisse des Teilscores Hocken                                                                      

4.1.6       Ergebnisse des Teilscores Instabilität                                                                   

4.1.7       Ergebnisse des Teilscores Schmerzen                                                                  

4.1.8       Ergebnisse des Teilscores Schwellung                                                                 

4.1.9       Ergebnisse des Teilscores Atrophie                                                                     

4.2          Flexion                                                                                                               

4.3          Streckdefizit                                                                                                       

4.4          Seitliche Achsabweichung                                                                                   

4.5          Gehstrecke                                                                                                         

4.6          Peri- und postoperativer Blutverlust                                                                     

4.7          Aufgetretene Komplikationen                                                                              

4.8          Bewertung durch die Patienten                                                                            

4.8.1       Beurteilung der Operation                                                                                   

4.8.2       Einschränkung durch die Operation                                                                     

4.9          Besondere Berücksichtigung der Patienten mit rheumatoider Arthritis                   

5             DISKUSSION                                                                                        

5.1          Rehabilitation nach Kniegelenkersatz                                                                   

5.2          Verwendung des periduralen Verweilkatheters                                                    

5.3          Komplikationen und Blutverlust                                                                           

5.4          Verwendung der Duracon-Prothese                                                                    

5.5          Verwendung der Endo-Prothese                                                                         

5.6          Vergleich von Duracon- und Endo-Prothese                                                        

5.7          Patienten mit rheumatoider Arthritis                                                                     

6             ZUSAMMENFASSUNG                                                                                

7             LITERATURVERZEICHNIS                                                                        

8             DANKSAGUNG                                                                                              

9             LEBENSLAUF                                                                                                

 

More Information:

Online available: http://www.diss.fu-berlin.de/2002/43/indexe.html
Language of PhDThesis: german
Keywords: Arthroplasty; knee; epidural catheter; epidural anaesthesia; early rehabilitation
DNB-Sachgruppe: 33 Medizin
Date of disputation: 17-May-2002
PhDThesis from: Fachbereich Humanmedizin, Freie Universität Berlin
First Referee: Prof. Dr. med. Martin Sparmann
Second Referee: Prof. Dr. med. Ulrich Weber
Contact (Author): alexhilss@yahoo.de
Date created:26-Mar-2002
Date available:02-Apr-2002

 

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