gms | German Medical Science

Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2022)

25. - 28.10.2022, Berlin

The impact of prehabilitation on the clinical outcome of patients with frailty syndrome after total hip arthroplasty – preliminary results and study protocol of a randomized controlled investigation

Meeting Abstract

  • presenting/speaker Henryk Haffer - CMSC, Charité – Universitätsmedizin Berlin, Berlin, Germany
  • Luis Alexander Becker - Charité – Universitätsmedizin Berlin, Klinik für Orthopädie und Unfallchirurgie, Centrum für Musculoskeletale Chirurgie, Berlin, Germany
  • Sonia A. Alves - Julius Wolff Institut, Charité – Universitätsmedizin Berlin, Berlin, Germany
  • Katharina Berghof - CMSC, Charité – Universitätsmedizin Berlin, Berlin, Germany
  • Moritz Petersen - CMSC, Charité – Universitätsmedizin Berlin, Berlin, Germany
  • Georg N. Duda - Julius Wolff Institut, Charité – Universitätsmedizin Berlin, Berlin, Germany
  • Carsten Perka - CMSC, Charité – Universitätsmedizin Berlin, Berlin, Germany
  • Tobias Winkler - Charité – Universitätsmedizin Berlin, Centrum für Muskuloskeletale Chirurgie, Julius Wolff Institut & Berlin Institute of Health, Berlin, Germany

Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2022). Berlin, 25.-28.10.2022. Düsseldorf: German Medical Science GMS Publishing House; 2022. DocAB66-288

doi: 10.3205/22dkou527, urn:nbn:de:0183-22dkou5272

Veröffentlicht: 25. Oktober 2022

© 2022 Haffer et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.


Gliederung

Text

Objectives: The frailty syndrome is a geriatric condition determined by decreased capacities in various physiological systems and associated with an increased risk for postoperative complications, longer hospital stays and death. Prehabilitative interventions have been performed in total hip arthroplasty (THA) patients and appear to improve patient reported outcomes (PROMs) and reduce the length of hospital stay. However, for the particularly vulnerable increasing patient population with frailty syndrome undergoing THA, data from randomized controlled trials are lacking. Therefore, we aimed to assess the effect of prehabilitation in patients with frailty syndrome undergoing THA in a randomized controlled investigation.

Methods: A randomized controlled study assessing the impact of prehabilitation in patients with frailty syndrome undergoing THA was conducted (ClinicalTrials.gov:NCT04418271). Randomization was performed with a two-arm parallel group design with an allocation ratio of 1:1. Patients in the intervention group completed a three-week prehabilitation program individually customized to their frailty symptoms after a shared-decision-making conference with the participation of orthopedics, geriatricians, anesthesiologists and physiotherapists. Frailty was determined by applying the criteria proposed by Fried et al. Baseline assessment (V1) included clinical examination, functional performance battery (Timed Up & Go, 2-minutes step test, gait speed, stair climbing speed) and PROMs (EQ-5D-5L, Hip disability and osteoarthritis outcome score (HOOS)). Follow-up examinations 3 months (V2) and 12 months (V3) postoperatively were scheduled as home visits. Differences between V1 and V2 were determined using the Wilcoxon signed-rank test and between the control and intervention group at V2 using the Mann-Whitney-U-test.

Results and conclusion: Preliminary data of N=6 patients (N=3 intervention: N=2 females; 83.7 years; BMI 26.4 kg/m2; N=3 control: N=2 females; 84.7 years; BMI 24.5 kg/m2) at V1 and V2 were analyzed. There were no significant differences between V1 and V2 in each the intervention and control group and no significant differences at V9 between the groups regarding the Timed Up & Go test, 2-minutes step test, gait speed, stair climbing speed, EQ-5D-5L subscales (mobility, self-care, usual activities, pain, anxiety) and HOOS subscales (symptoms, pain, activities of daily living, recreational activities, quality of life) detected.

We are pleased to present preliminary results and the study protocol of a randomized controlled trial on the clinical and functional outcome after a three-week individually adapted prehabilitation intervention in patients with frailty syndrome undergoing THA. The current reduced sample size might be a factor influencing the present results. As the study inclusion continues, we will be able to present larger patient numbers at the DKOU and may demonstrate the influence of prehabilitation.