| Abstract | Minimalno invazivna artroplastika kuka i koljena novi je kirurški pristup koji omogućava brojne prednosti u liječenju i oporavku danas sve većeg broja bolesnika koji traže ovakvu vrstu zahvata. Minimalno invazivna artroplastika izvodi se kroz manji rez na koži, uz minimalnu traumu mekih tkiva i manje krvne gubitke. Moguće su značajne uštede uz manje perioperacijske komplikacije i uz bolje zadovoljstvo bolesnika. Djelomična ili totalna artroplastika zgloba kuka i koljena na dnevnoj bazi moguća je zahvaljujući unaprijeĎenoj zdravstvenoj skrbi. Ono što omogućuje sigurnost bolesnika, uspješnost ishoda te manje razloga za hospitalizaciju je primjena multidisciplinarnih protokola koji se odnose na odabir bolesnika, ubrzanu rehabilitaciju, optimizaciju popratnih bolesti pri čemu anesteziolog igra važnu ulogu te edukaciju bolesnika i svih koji su uključeni u proces njihovog zbrinjavanja. Bolesnikova očekivanja s obzirom na konačni ishod kirurškog liječenja i očekivanja bolesnikove obitelji često su pretjerano optimistična glede krajnjeg funkcionalnog ishoda operiranih zglobova. Stoga je edukacija izuzetno bitna kako bi se očekivanja svela u realnije okvire. Tzv. "fast track" metode se odnose na primjenu antifibrinolitika radi smanjenja krvarenja prilikom zahvata, na odabir prikladne anesteziološke tehnike, profilaksu poslijeoperacijskih mučnina i povraćanja, ubrzanu fizikalnu terapiju, rano ustajanje i kretanje a sve s ciljem poboljšanja kirurških ishoda. Rehabilitacija započinje odmah nakon oporavka od anestezije i evaluacije odnosno procjene funkcionalnog stanja zglobova i mišićne snage te suradljivosti bolesnika od strane fizijatra i fizioterapeuta do oporavka uz kućnu fizikalnu terapiju. Pozitivnim ishodima artroplastike i njihovom razvoju pridonosi cjelokupni perioperacijski tim u kojeg pripadaju ortopedski kirurzi, anesteziolozi, medicinske sestre/tehničari, fizijatri i fizioterapeuti, radni terapeuti, nutricionisti te pomoćno osoblje. Razvoj multimodalnih algoritama proizlazi iz stalnog poboljšanja kirurških, anesteziološkh i analgetskih tehnika, prehrane i edukacije bolesnika i rane fizikalne terapije čime se povećava sigurnost bolesnika i postiže učinkovitost zahvata. Artroplastika kuka i koljena omogućava bolji način života, postiže se manja bolnost i bolja funkcija zgloba. U mnogim zemljama a meĎu njima i u Hrvatskoj do danas nisu stečeni potrebni preduvjeti za izvoĎenje ovakvih vrsta zahvata u dnevnoj kirurgiji. Očekuju se pritisci kao zbog medicinskih tako i ekonomskih razloga u nastojanju da se što bolje iskoriste ograničeni financijski izvori u zdravstvu. Stoga je potrebno što ranije pripremiti potrebne uvjete za nadolazeći trend izvoĎenja totalne i djelomične artroplastike kuka i koljena kao isplativog i sigurnog zahvata u dnevnoj ortopediji |
| Abstract (english) | The minimal invasive hip and knee arthroplasty is a new surgical approach that provides many benefits in the treatment and recovery of today's increasing number of patients looking for this type of procedure. The minimal invasive arthroplasty is performed through a smaller skin incision, with minimal trauma of soft tissues and less blood loss. Significant savings can be achieved with less perioperative complications and better patient satisfaction. Partial or total arthroplasty of the hip and knee joint on a daily basis is possible thanks to improved health care. What enables patient safety, outcome performance and fewer reasons for hospitalization is the application of multidisciplinary protocols related to patient selection, accelerated rehabilitation, optimization of accompanying diseases, where an anesthesiologist plays an important role and educates patients and everyone involved in the process of their care. Patient's expectations with regard to the ultimate outcome of surgical treatment and the expectation of the patient's family are often overly optimistic with regard to the ultimate functional outcome of the operative joints, therefore education is essential to bring expectations to more realistic frameworks. So called. "Fast track" methods refer to the use of antifibrinolytics to reduce bleeding during surgery, to select appropriate anesthetic techniques, postoperative nausea and vomiting prophylaxis, accelerated physical therapy, early onset and motion, all with the aim of improving surgical outcomes. Rehabilitation begins immediately after the recovery from anesthesia and evaluation of the functional condition of the joints and muscle strength, and the co-operation between the patient's physician and physiotherapist to the recovery, along with home physical therapy. Positive outcomes of arthroplasty and their development contribute to the overall perioperative team involving orthopedic surgeons, anesthesiologists, nurses/technicians, physiatrists and physiotherapists, work therapists, nutritionists and assistance staff. The development of multimodal algorithms stems from the constant improvement of surgical, anesthesiologic and analgesic techniques, diet and patient education and early physical therapy, which increases patient safety and achieves efficacy of the procedure. The artroplasty of the hip and knee provides a better lifestyle, less pain and better wrist function. In many countries, and among them, in Croatia, unfortunately, the necessary preconditions for performing such types of interventions in day surgery have not yet been obtained. Expectations are expected for both medical and economic reasons to make the best use of limited financial resources in healthcare,
so it is necessary to prepare the necessary conditions for the upcoming trend of performing total and partial hip and knee arthroplasty as a viable and safe operation in daily orthopedics |
