Special orthopaedic geriatrics (SOG) - a new multiprofessional care model for elderly patients in elective orthopaedic surgery: a study protocol for a prospective randomized controlled trial of a multimodal intervention in frail patients with hip and knee replacement

Abstract

Background Due to demographic change, the number of older people in Germany and worldwide will continue to rise in the coming decades. As a result, the number of elderly and frail patients undergoing total hip and knee arthroplasty is projected to increase significantly in the coming years. In order to reduce risk of complications and improve postoperative outcome, it can be beneficial to optimally prepare geriatric patients before orthopaedic surgery and to provide perioperative care by a multiprofessional orthogeriatric team. The aim of this comprehensive interventional study is to assess wether multimorbid patients can benefit from the new care model of special orthopaedic geriatrics (SOG) in elective total hip and knee arthroplasty. Methods The SOG study is a registered, monocentric, prospective, randomized controlled trial (RCT) funded by the German Federal Joint Committee (GBA). This parallel group RCT with a total of 310 patients is intended to investigate the specially developed multimodal care model for orthogeriatric patients with total hip and knee arthroplasty (intervention group), which already begins preoperatively, in comparison to the usual orthopaedic care without orthogeriatric co-management (control group). Patients ≥70 years of age with multimorbidity or generally patients ≥80 years of age due to increased vulnerability with indication for elective primary total hip and knee arthroplasty can be included in the study. Exclusion criteria are age < 70 years, previous bony surgery or tumor in the area of the joint to be treated, infection and increased need for care (care level ≥ 4). The primary outcome is mobility measured by the Short Physical Performance Battery (SPPB). Secondary outcomes are morbidity, mortality, postoperative complications, delirium, cognition, mood, frailty, (instrumental) activities of daily living, malnutrition, pain, polypharmacy, and patient reported outcome measures. Tertiary outcomes are length of hospital stay, readmission rate, reoperation rate, transfusion rate, and time to rehabilitation. The study data will be collected preoperative, postoperative day 1 to 7, 4 to 6 weeks and 3 months after surgery. Discussion Studies have shown that orthogeriatric co-management models in the treatment of hip fractures lead to significantly reduced morbidity and mortality rates. However, there are hardly any data available on the elective orthopaedic care of geriatric patients, especially in total hip and knee arthroplasty. In contrast to the care of trauma patients, optimal preoperative intervention is usually possible. Trial registration German Clinical Trials Register DRKS00024102. Registered on 19 January 2021.

A Proposal for a Multidisciplinary Integrated Oral Health Network for Patients Undergoing Major Orthopaedic Surgery (IOHN-OS)

“…The common denominators in these cases are smoking, polymorbidity, and malnutrition [ 2 ]. Improving outcomes requires innovations, both in surgery and in the peri-operative path of care [ 3 ]. This approach is more likely to correct modifiable physical, mental, and social conditions of vulnerability [ 4 ].…”

SOG—Special Orthopedic Geriatrics

“…Gerade hier bleibt das große Potenzial, den geriatrischen und oftmals multimorbiden Patienten bereits im Vorfeld optimal auf die Operation vorzubereiten, ihn vor der Operation altersmedizinisch vorzustellen und bereits präoperativ ein umfassendes geriatrisches Assessment zu erheben, bisher ungenutzt [ 19 ]. An der Klinik und Poliklinik für Orthopädie der Universität Regensburg am Asklepios Klinikum Bad Abbach wurde folglich das orthogeriatrische Versorgungsmodell „Spezielle Orthopädische Geriatrie (SOG)“ entwickelt, welches aktuell im Rahmen einer durch den Innovationsfonds des G‑BA geförderten, randomisierten kontrollierten Studie (RCT) bei geriatrischen Patienten mit elektivem Hüft- und Kniegelenkersatz evaluiert wird [ 13 ].…”

“…Ziel der Studie ist es, den Effekt einer integrierten orthogeriatrischen Versorgung im Vergleich zur rein orthopädischen Standardversorgung bei geriatrischen Patienten in der elektiven, primären Hüft- und Kniegelenkendoprothetik anhand multipler validierter Parameter zu evaluieren [ 13 ]. Primäre Zielgröße ist die Mobilität, gemessen anhand der Short Physical Performance Battery (SPPB) [ 7 ].…”

Dementia and Hip Fractures

“…Prior work has focused on the development of orthogeriatric teams to execute strategies of optimizing outcomes in trauma and joint replacement patients 2,4,8 . Pioli et al conceptualized the orthogeriatric care model as not just a multidisciplinary activity but rather a radical alternative to the traditional model 9 .…”

“…Causes of this mortality include pulmonary embolism, heart failure, and infections 2 . Further complicating matters, the geriatric population faces additional challenges such as comorbidities, polypharmacy, malnutrition, sarcopenia, immobility, and cognitive impairments, among others 4 . These changing demographics necessitate a comprehensive approach to patient care.…”