{"id":13784,"date":"2023-10-26T11:53:33","date_gmt":"2023-10-26T11:53:33","guid":{"rendered":"https:\/\/leicesterleicestershireandrutland.icb.nhs.uk\/?p=13784"},"modified":"2023-11-23T15:33:14","modified_gmt":"2023-11-23T15:33:14","slug":"llr-policy-for-hip-and-knee-replacement","status":"publish","type":"post","link":"https:\/\/leicesterleicestershireandrutland.icb.nhs.uk\/ro\/llr-policy-for-hip-and-knee-replacement\/","title":{"rendered":"Politica LLR pentru protec\u021bia \u0219oldului \u0219i a genunchiului"},"content":{"rendered":"

Categoria<\/strong><\/p>\n\n\n\n

Criterii de prag<\/p>\n\n\n\n

Aproximativ 160.000 de proceduri de \u00eenlocuire a \u0219oldului \u0219i genunchiului sunt efectuate anual \u00een Anglia \u0219i \u021aara Galilor \u0219i exist\u0103 o tendin\u021b\u0103 na\u021bional\u0103 de cre\u0219tere a cererii pentru acestea. Osteoartrita este cea mai frecvent\u0103 indica\u021bie pentru aceste proceduri de \u00eenlocuire a articula\u021biilor.<\/p>\n\n\n\n

Eligibilitate<\/strong><\/p>\n\n\n\n

LLR ICB va finan\u021ba protec\u021bia \u0219oldului \u0219i a genunchiului numai atunci c\u00e2nd sunt \u00eendeplinite toate criteriile urm\u0103toare<\/strong>

Criterii de pre referire<\/strong>

\u00b7 Pacientul ar fi trebuit v\u0103zut \u00een persoan\u0103 \u0219i examinat cu privire la \u0219old\/genunchi pentru a confirma patologia relevant\u0103 pentru aceast\u0103 procedur\u0103.
\u00b7 Anemia investigat\u0103 \u0219i tratat\u0103 pentru a aduce Hb >115 la femei \u0219i >130 la b\u0103rba\u021bi. Opera\u021bia nu va avea loc p\u00e2n\u0103 c\u00e2nd acestea nu sunt corectate.
\u00b7 Diabet controlat cu HbA1c <8,5. Opera\u021bia nu este posibil\u0103 dec\u00e2t dac\u0103 este tratat\u0103. \u00a0
\u00b7 IMC <45. Se recomand\u0103 trimiterea c\u0103tre serviciul de management al greut\u0103\u021bii Nivelul 3 dac\u0103 IMC>35. Chirurgia este nu <\/strong>oferit celor cu IMC>45.
\u00b7 Hipertensiune arterial\u0103 tratat\u0103 cu sistolice <150mmHg
\u00b7 Comorbidit\u0103\u021bi medicale preexistente optimizate

\u0218I<\/strong>

Tratament conservator de 3 luni care include:
o un program de exerci\u021bii,
o dispozitive de asisten\u021b\u0103, de exemplu, ajutoare pentru mers, acolo unde este indicat
o discu\u021bii despre gestionarea greut\u0103\u021bii \u0219i renun\u021barea la fumat, dup\u0103 caz
o utilizarea terapiei farmacologice pentru controlul simptomelor

\u0218I<\/strong>

\u00b7 Confirmarea c\u0103 pacientul este dispus s\u0103 fie supus unei interven\u021bii chirurgicale

\u0218I<\/strong>
\u00b7 Dovezi c\u0103 beneficiile \u0219i riscurile poten\u021biale ale interven\u021biei chirurgicale au fost explicate folosind un instrument comun de luare a deciziilor<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n
Criterii de trimitere (pe baza clasific\u0103rii durerii \u0219i a limit\u0103rii func\u021bionale de mai jos)<\/strong>
\u00b7 Simptomatologie intensa sau severa

\u0218I\/SAU<\/strong>
\u00b7 Limit\u0103ri func\u021bionale moderate sau severe

\u0218I<\/strong>
\u00b7 Constat\u0103ri pozitive ale examenului clinic \u00een articula\u021bia specificat\u0103

\u0218I<\/strong>
. Raze X care arat\u0103 orice semne radiologice de boal\u0103 degenerativ\u0103 au fost efectuate \u00een decurs de 6 luni de la trimitere. Condi\u021biile se schimb\u0103 \u00een timp \u0219i apar noi diagnostice, a\u0219a c\u0103 o radiografie trebuie s\u0103 fie contemporan\u0103 trimiterii.<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n

Trimitere urgent\u0103 f\u0103r\u0103 tratament conservator de 3 luni<\/strong><\/p>\n\n\n\n

LLR ICB va finan\u021ba numai atunci c\u00e2nd sunt \u00eendeplinite urm\u0103toarele criterii<\/strong>

\u00b7 Simptomatologie sever\u0103
 
SAU<\/strong>
\u00b7 Limitare func\u021bional\u0103 sever\u0103
 <\/strong>
\u0218I<\/strong>
. simptomologie moderat\u0103, intens\u0103 sau sever\u0103<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n

Clasificarea simptomologiei \u0219i limitarea func\u021bional\u0103 <\/strong><\/p>\n\n\n\n

SIMPTOMOLOGIE<\/strong><\/td><\/tr>
U\u015for<\/strong>
\u2013 Durere rar
\u2013 Durere la urcarea\/coborarea scarilor
\u2013 Capabil s\u0103 desf\u0103\u0219oare activit\u0103\u021bi zilnice, cu excep\u021bia celor care necesit\u0103 o activitate fizic\u0103 mare
\u2013 Medicamente luate pentru controlul durerii f\u0103r\u0103\/ pu\u021bine efecte secundare<\/td><\/tr>
Moderat<\/strong>
\u2013 Dureri ocazionale
\u2013 Durere la mers sau \u00een picioare pe suprafe\u021be plane timp de o jum\u0103tate de or\u0103
\u2013 O anumit\u0103 limitare a activit\u0103\u021bilor zilnice
\u2013 Medicamente luate pentru a controla durerea f\u0103r\u0103\/pu\u021bine efecte secundare<\/td><\/tr>
Intens <\/strong>
\u2013 Durere aproape continu\u0103
\u2013 Durere la mers pe distan\u021be scurte sau la stat pe suprafe\u021be plane mai pu\u021bin de jum\u0103tate de or\u0103
\u2013 Limitarea semnificativ\u0103 a activit\u0103\u021bilor zilnice
\u2013 Medicamente luate \u00een mod continuu pentru a face efect
\u2013 Utilizarea ocazional\u0103 a sistemelor de sprijin, de exemplu, ajutoare pentru mers<\/td><\/tr>
Sever\u0103<\/strong>
\u2013 Durere continu\u0103
\u2013 Durere \u00een repaus
\u2013 Limitarea semnificativ\u0103 constant\u0103 a activit\u0103\u021bilor zilnice
\u2013 Utilizarea continu\u0103 a medicamentelor f\u0103r\u0103 r\u0103spuns sau efect advers
\u2013 Utilizarea constant\u0103 a sistemelor de sprijin, de exemplu, ajutoare pentru mers<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n
LIMITARE FUNC\u021aIONAL\u0102 <\/strong><\/td><\/tr>
Minor<\/strong>
\u2013 Capacitate func\u021bional\u0103 adecvat\u0103 pentru a desf\u0103\u0219ura activit\u0103\u021bi normale \u0219i auto\u00eengrijire
\u2013 Capacitate de mers pe jos mai mult de o or\u0103
\u2013 Nu este nevoie de ajutoare<\/td><\/tr>
Moderat <\/strong>
\u2013 Capacitate func\u021bional\u0103 adecvat\u0103 pentru a efectua doar c\u00e2teva sau niciuna dintre activit\u0103\u021bile normale \u0219i auto\u00eengrijirea
\u2013 Capacitate de mers pe jos de aproximativ o jum\u0103tate de or\u0103
\u2013 Ajutor, de exemplu, este necesar un baston de mers<\/td><\/tr>
Sever\u0103<\/strong>
\u2013 \u00cen mare m\u0103sur\u0103 sau total incapacitate
\u2013 Capacitate de mers sub o jum\u0103tate de or\u0103 sau imposibilitatea de a merge sau imobilizat la pat
\u2013 Utilizarea constant\u0103 a ajutoarelor, de exemplu, bastoane, premerg\u0103tor sau scaun cu rotile<\/td><\/tr><\/tbody>
Adaptat dup\u0103: Joint Planned Care Lead for North Kirklees and Wakefield CCG. Politica de punere \u00een func\u021biune a CCG NHS North Kirklees \u0219i Wakefield. 2017<\/em><\/td><\/tr><\/tfoot><\/table><\/figure>\n\n\n\n

Instrumentul Oxford Scoring este op\u021bional \u0219i poate fi utilizat \u00een cadrul consulta\u021biei clinice pentru a explora impactul asupra pacien\u021bilor, preocup\u0103rile acestora \u0219i pentru a revizui progresia afec\u021biunii.<\/p>\n\n\n\n

Anexa A ilustreaz\u0103 criteriile de trimitere.<\/em><\/p>\n\n\n\n

<\/p>\n\n\n\n

\u00cendrumare <\/strong><\/p>\n\n\n\n

https:\/\/pathways.nice.org.uk\/pathways\/osteoarthritis#path=view%3A\/pathways\/osteoarthritis\/management-of-osteoarthritis.xml&content=view-quality-statement%3Aqualitystatements-referral-for-consideration-of-joint-surgery<\/a>
 
 
Asocia\u021bia Britanic\u0103 de Ortopedie, Colegiul Regal al Chirurgilor. Ghid de punere \u00een func\u021biune: Durerea care apare de la \u0219old la adul\u021bi. 2017.
 
Asocia\u021bia Britanic\u0103 de Ortopedie, Colegiul Regal al Chirurgilor. Ghid de punere \u00een func\u021biune: Osteoartrita dureroas\u0103 a genunchiului. 2017.<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n

Anexa A <\/strong><\/p>\n\n\n\n

\"\"<\/figure>\n\n\n\n
Data revizuirii ARP 53: 2026<\/td><\/tr><\/tbody><\/table><\/figure>","protected":false},"excerpt":{"rendered":"

Category Threshold Criteria Approximately 160,000 hip and knee replacement procedures are performed annually in England and Wales and there is a national trend towards increasing demand for these. 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