Traumatology and Orthopedics of RussiaTraumatology and Orthopedics of RussiaТравматология и ортопедия России2311-29052542-0933Vreden National Medical Research Center of Traumatology and Orthopedics202010.17816/2311-2905-2020Trauma and orthopedic careОрганизация травматолого-ортопедической помощиTrauma and orthopedic careResearch ArticleFollow-Up After Hip and Knee Arthroplasty: a Review of the Literature and a Report on a Pilot Project at the Vreden National Medical Research Center of Traumatology and OrthopedicsНаблюдение пациентов после эндопротезирования тазобедренного и коленного суставов: обзор литературы и доклад о пилотном проекте Национального медицинского исследовательского центра травматологии и ортопедии им. Р.Р. Вреденаhttps://orcid.org/0000-0001-7500-9219SeredaAndrei P.СередаАндрей Петрович
Russian Federation

Dr. Sci. (Med.)

д-р мед. наук

drsereda@gmail.comhttps://orcid.org/0000-0002-6745-4707DzhavadovAlisagib A.ДжавадовАлисагиб Аббасович
Russian Federation

Cand. Sci. (Med.)

канд. мед. наук

alisagib.dzhavadov@mail.ruhttps://orcid.org/0000-0002-1176-612XChernyAlexander A.ЧерныйАлександр Андреевич
Russian Federation

Cand. Sci. (Med.)

канд. мед. наук

alexander.cherny.spb@gmail.comhttps://orcid.org/0000-0002-7123-5582BilykStanislav S.БилыкСтанислав Сергеевич
Russian Federation

Cand. Sci. (Med.)

канд. мед. наук

bss0413@gmail.comhttps://orcid.org/0000-0003-0828-7678DenisovAlexey O.ДенисовАлексей Олегович
Russian Federation

Cand. Sci. (Med.)

канд. мед. наук

med-03@ya.ruhttps://orcid.org/0000-0003-0218-3106ShubnyakovIgor I.ШубняковИгорь Иванович
Russian Federation

Dr. Sci. (Med.)

д-р мед. наук

shubnyakov@mail.ruhttps://orcid.org/0000-0002-6398-2377KornilovNikolai N.КорниловНиколай Николаевич
Russian Federation

Dr. Sci. (Med.)

д-р мед. наук

drkornilov@hotmail.comhttps://orcid.org/0000-0002-1557-1899AvdeevAlexander I.АвдеевАлександр Игоревич
Russian Federation

Cand. Sci. (Med.)

канд. мед. наук

spaceship1961@gmail.comhttps://orcid.org/0000-0002-0301-8439StolyarovAlexey А.СтоляровАлексей Александрович
Russian Federation

Cand. Sci. (Med.)

канд. мед. наук

Drstolyarov@gmail.comhttps://orcid.org/0000-0001-9415-0023DeminAlexander S.ДеминАлександр Сергеевич
Russian Federation
demin-medic@mail.ruhttps://orcid.org/0000-0003-0733-2414TikhilovRashid M.ТихиловРашид Муртузалиевич
Russian Federation

Dr. Sci. (Med.), Professor

д-р мед. наук, чл.-корр. РАН, профессор

rtikhilov@gmail.comVreden National Medical Research Center of Traumatology and OrthopedicsФГБУ «Национальный медицинский исследовательский центр травматологии и ортопедии им. Р.Р. Вредена» Минздрава РоссииAcademy of Postgraduate Education of Federal Medical Biological AgencyАкадемия постдипломного образования ФГБУ «Федеральный научно-клинический центр специализированных видов медицинской помощи и медицинских технологий ФМБА России»Mechnikov North-Western State Medical UniversityФГБОУ ВО «Северо-Западный государственный медицинский университет им. И.И. Мечникова» Минздрава РоссииStavropol State UniversityФГБОУ «Ставропольский государственный университет»Vreden National Medical Research Center of Traumatology and OrthopedicsФГБУ «Национальный медицинский исследовательский центр травматологии и ортопедии им. Р.Р. Вредена» Минздрава России130220231104202329160720111202231012023Copyright ©; 2023, Eco-VectorCopyright ©; 2023, Эко-ВекторCopyright ©; 2023,2023Eco-VectorЭко-Векторhttps://creativecommons.org/licenses/by-nc-nd/4.0https://journal.rniito.org/jour/article/view/2020

Background. Today in our country, the follow-up of patients after arthroplasty is carried out in accordance with clinical guidelines, the wording of which is based on monographs from 2006, 2008, and 2014, in addition, clinical guidelines for follow-up do not take into account the results of treatment assessed by the patient himself.

The purpose of this study was to examine existing systems and develop a proprietary follow-up system for patients after hip and knee arthroplasty.

Results. A review of the literature revealed that follow-up of patients after arthroplasty is an unsolved problem, within which there is low coverage, reluctance or forgetfulness of the asymptomatic patient, the problem of accessibility of medical examinations, and an excessive financial burden on the health care system. Since 2022, fixed recommendations for follow-up after arthroplasty have been used in the clinical practice of our center in discharge epicrisis. Recommendations for the frequency of follow-up were formulated by experts based on a comprehensive review of the literature and their own experience. In the first three months, 221 hip and 235 knee evaluation questionnaires were collected through the proposed mechanism, with a progressive increase in the number of questionnaires based on weekly monitoring data.

Conclusion. Unfortunately, the outpatient clinic system is not always able to provide qualitative monitoring of patients after arthroplasty due to various reasons, therefore, in our opinion, the implementation of the mechanism of remote monitoring of patients will allow detecting various complications at the stage of early diagnosis, which will contribute to prompt solution of these problems. The remote monitoring system is also an important source of scientific data.

Актуальность. На сегодняшний день в России диспансерное наблюдение за пациентами после эндопротезирования осуществляется в соответствии с клиническими рекомендациями, формулировки из которых основаны на монографиях 2006, 2008 и 2014 гг. Кроме того, клинические рекомендации по диспансерному наблюдению не учитывают результаты лечения, оцененные самим пациентом.

Целью данного исследования было изучение существующих систем и разработка собственной системы наблюдения за пациентами после эндопротезирования тазобедренного и коленного суставов.

Результаты. Обзор литературы выявил, что наблюдение за пациентами после эндопротезирования представляет собой нерешенную проблему, составляющими которой являются низкий охват, нежелание или забывчивость асимптомных пациентов, проблема доступности медицинских осмотров, избыточная финансовая нагрузка на систему здравоохранения. С 2022 г. в клинической практике НМИЦ ТО им. Р.Р. Вредена в выписных эпикризах используются рекомендации по наблюдению после эндопротезирования. Рекомендации по периодичности наблюдений были сформулированы экспертами на основе всестороннего обзора литературы и собственного опыта. За первые три месяца собрана 221 анкета по оценке тазобедренного сустава и 235 — коленного сустава, причем число анкет по данным еженедельного мониторинга прогрессивно возрастает.

Заключение. К сожалению, поликлиническая система не всегда может обеспечить качественное наблюдение за пациентами после эндопротезирования в силу различных причин, поэтому реализация механизма удаленного наблюдения за пациентами, на наш взгляд, позволит выявлять на этапе ранней диагностики различные осложнения, что будет способствовать оперативному решению данной проблемы. Также система удаленного наблюдения представляет собой важный источник научных данных.

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