Nöth U, Geiser T, Kranich T, von Rottkay E, Reichert J C, Reyle-Hahn M, Rackwitz L
Klinik für Orthopädie und Unfallchirurgie, Evangelisches Waldkrankenhaus Spandau, Stadtrandstraße 555, 13589, Berlin, Deutschland.
Klinik für Anästhesie und interdisziplinäre Intensivmedizin, Evangelisches Waldkrankenhaus Spandau, Berlin, Deutschland.
Orthopade. 2019 Apr;48(4):330-336. doi: 10.1007/s00132-019-03697-7.
Fast track arthroplasty is becoming increasingly accepted in German-speaking countries. By optimizing treatment processes fast track programs promise faster recovery, increased patient satisfaction, quality improvement and reduction in the length of hospital stay.
The philosophy and treatment principles of fast track hip arthroplasty during the pre, intra and postoperative phase are described in the light of the current body of evidence. The challenges concerning fast track arthroplasty within the German health system are discussed.
Besides presenting our own data concerning a patient seminar and an opiate saving pain treatment, the most relevant literature related to fast track hip arthroplasty from a pubmed search is discussed.
Fast track concepts can only be successfully implemented through close interdisciplinary team work. Preoperatively, a patient seminar can help to prepare patients better for surgery. Postoperatively, early mobilisation and pain treatment play a central role, whereat a clear reduction in opiate application can be achieved.
Fast track hip arthroplasty makes rethinking with respect to traditional treatment principles necessary and demands a high degree of interdisciplinary team work. Particularly, as result of the specifics of the health system (DRG system and stationary rehabilitation), a nationwide establishment in Germany has not taken place so far.
快速通道关节置换术在德语国家越来越被接受。通过优化治疗流程，快速通道项目有望实现更快康复、提高患者满意度、改善质量并缩短住院时间。
根据当前证据阐述快速通道髋关节置换术在术前、术中和术后阶段的理念及治疗原则。讨论德国医疗体系中快速通道关节置换术面临的挑战。
除了展示我们自己关于患者研讨会和阿片类药物节省型疼痛治疗的数据外，还讨论了从PubMed搜索中获取的与快速通道髋关节置换术最相关的文献。
快速通道理念只有通过紧密的跨学科团队合作才能成功实施。术前，患者研讨会有助于患者更好地为手术做准备。术后，早期活动和疼痛治疗起着核心作用，在此过程中可实现阿片类药物应用的明显减少。
快速通道髋关节置换术需要对传统治疗原则进行重新思考，并要求高度的跨学科团队合作。特别是由于医疗体系的特殊性（诊断相关分组系统和住院康复），德国目前尚未在全国范围内开展。
