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A osteoartrose (OA) de joelho é uma das doenças osteomioarticulares mais comuns no mundo, afetando 2693 em cada 100.000 mulheres e 1770 em cada 100.000 homens. Embora o treinamento de força (TF) seja amplamente recomendado para a melhoria das debilidades físicas encontradas em pacientes com OA, o uso de cargas entre 70-85% da força dinâmica máxima (FDM) pode ser limitado não somente pela dor, mas também pela própria etiologia da doença, representando uma limitação para esta prática. O treinamento de força associado à oclusão vascular (TFOV) baseia-se na execução do TF em intensidades entre 20 e 50% da FDM, combinado à oclusão do fluxo sanguíneo através do uso de torniquetes. Estudos têm mostrado que a magnitude das mudanças na força e massa musculares após um período de treinamento com esta técnica é similar as causadas pelo TF de alta intensidade (70-85% FDM) sem adição da oclusão vascular. O objetivo do presente trabalho foi investigar a eficácia da associação da oclusão vascular ao TF como modelo de intervenção não farmacológica para melhoria da dor, força muscular, funcionalidade e qualidade de vida em pacientes diagnosticadas com OA de joelho. Diante disso, 48 participantes mulheres foram randomicamente distribuídas em três grupos: treinamento de força de baixa intensidade (TFB), treinamento de força de alta intensidade (TFA) ou treinamento de força de baixa intensidade associado à oclusão vascular (TFOV) e receberam treinamento duas vezes por semana durante doze semanas. No período basal e após a intervenção, as pacientes passaram por avaliações físicas (testes de funcionalidade e força), responderam questionários de qualidade de vida e de dor (índice WOMAC \"Western Ontario and McMaster Universities Osteoarthritis Index\" e SF-36 \"The Short Form 36 Health Survey\") e exame de imagem da área da secção transversa (AST) do músculo quadríceps por meio de tomografia computadorizada. Durante o período de treinamento, quatro pacientes do grupo TFA foram excluídas do protocolo por dor no joelho. Após a intervenção, no WOMAC, apenas os grupos TFOV e TFB apresentaram diminuições significativas na dor (p=0,0358 e p=0,0044, respectivamente), nos demais domínios, o único grupo que apresentou diminuições significativas de escore foi o TFOV (rigidez: p=0,0167 e funcionalidade p=0,0358). Nos testes de funcionalidade, os grupos TFOV e TFA apresentaram aumentos significativos no desempenho do \"Timed-stands test\" (p=0,0251 e p=0,003), no \"Timed-up-and-go\" não foram encontradas melhoras significantes nos grupos. Com relação a força, apenas os grupos TFOV e TFA aumentaram significativamente os valores no leg-press (p<0,0001) e na extensão de joelhos (p<0,0001). Comportamento similar foi encontrado no aumento da AST, grupos TFOV e TFA apresentaram aumentos significativos (p<0,0001). A melhora de qualidade de vida foi significante nos três grupos quando analisamos a somatória dos domínios do WOMAC (TFOV: p=0,0173; TFA: p=0,0438; TFB: p=0,0301), porém o SF-36 não foi capaz encontrar melhoras significativas nos grupos. Dessa forma, concluímos que o TFOV apresenta-se como uma estratégia relevante e segura de intervenção não farmacológica para mulheres acometidas por OA sintomática de joelhos, constituindo um modelo de tratamento capaz de induzir adaptações funcionais e morfológicas de grande interesse para esta população / Osteoarthritis (OA) of the knee is one of the most common articular disease worldwide, affecting 100,000 women in 2693 and 1770 in every 100,000 men. Although strength training (ST) is widely recommended for improving the physical weaknesses found in patients with OA, using loads between 70-85% of maximal dynamic strength (MDS) can be limited not only by pain, but also by the own etiology of the disease, representing a limitation of this practice. Strength training associated with vascular occlusion (STVO) is based on the execution of the ST at intensities between 20 and 50% of MDS, combined with the occlusion of blood flow through the use of tourniquets. Studies have shown that the magnitude of changes in strength and muscle mass after a period of training this technique is similar to those caused by high-intensity ST (MDS 70-85%) without the addition of the vascular occlusion. The objective of this study was to investigate the efficacy of the combination of vascular occlusion to the ST as non pharmacologic intervention model for improving pain, muscle strength, functionality and quality of life in patients diagnosed with knee OA. Thus, 48 women participants were randomly divided into three groups: strength training low intensity (STL), strength training, high intensity (STH) or low-intensity strength training associated with vascular occlusion (STVO) and trained two times per week for twelve weeks. At baseline and after the intervention, the patients underwent physical assessments (tests of functionality and strength), answered questionnaires on quality of life and pain (WOMAC index \"Western Ontario and McMaster Universities Osteoarthritis Index\" and SF-36 \"The Short form 36 Health Survey \") and the cross section area (CSA) of the quadriceps muscle was assessed using computed tomography. During the training period the STH group, four patients were excluded from the protocol due to knee pain. After the intervention, the WOMAC, only the STVO and STL groups showed significant decreases in pain (p=0.0358 and p=0.0044, respectively), in other domains, the only group that showed significant decreases in score was the STVO (stiffness: p= 0.0167 and p = 0.0358 functionality). In functionality testing, the STVO and STH groups showed significant increases in performance \"Timed-stands test\" (p=0.0251 and p=0.003), the \"Timed-up-and-go\" were not significant improvements found in groups. Regarding strength, only the STVO and STH groups significantly increased values in leg press (p<0.0001) and knee extension (p<0.0001). Similar behavior was found in increased AST and STH STVO groups showed significant increases (p<0.0001). The improvement of quality of life was significant in all three groups when analyzing the sum of the domains of WOMAC (STVO: p=0.0173; STH: p=0.0438; STL: p=0.0301), but the SF-36 was not able to find significant improvements in groups. Thus, we conclude that the STVO presents itself as a relevant and safe strategy of non-pharmacological intervention for women suffering from symptomatic knee OA, constituting a model of treatment capable of inducing functional and morphological adaptations of great interest to this population

A osteoartrose (OA) de joelho é uma das doenças osteomioarticulares mais comuns no mundo, afetando 2693 em cada 100.000 mulheres e 1770 em cada 100.000 homens. Embora o treinamento de força (TF) seja amplamente recomendado para a melhoria das debilidades físicas encontradas em pacientes com OA, o uso de cargas entre 70-85% da força dinâmica máxima (FDM) pode ser limitado não somente pela dor, mas também pela própria etiologia da doença, representando uma limitação para esta prática. O treinamento de força associado à oclusão vascular (TFOV) baseia-se na execução do TF em intensidades entre 20 e 50% da FDM, combinado à oclusão do fluxo sanguíneo através do uso de torniquetes. Estudos têm mostrado que a magnitude das mudanças na força e massa musculares após um período de treinamento com esta técnica é similar as causadas pelo TF de alta intensidade (70-85% FDM) sem adição da oclusão vascular. O objetivo do presente trabalho foi investigar a eficácia da associação da oclusão vascular ao TF como modelo de intervenção não farmacológica para melhoria da dor, força muscular, funcionalidade e qualidade de vida em pacientes diagnosticadas com OA de joelho. Diante disso, 48 participantes mulheres foram randomicamente distribuídas em três grupos: treinamento de força de baixa intensidade (TFB), treinamento de força de alta intensidade (TFA) ou treinamento de força de baixa intensidade associado à oclusão vascular (TFOV) e receberam treinamento duas vezes por semana durante doze semanas. No período basal e após a intervenção, as pacientes passaram por avaliações físicas (testes de funcionalidade e força), responderam questionários de qualidade de vida e de dor (índice WOMAC \"Western Ontario and McMaster Universities Osteoarthritis Index\" e SF-36 \"The Short Form 36 Health Survey\") e exame de imagem da área da secção transversa (AST) do músculo quadríceps por meio de tomografia computadorizada. Durante o período de treinamento, quatro pacientes do grupo TFA foram excluídas do protocolo por dor no joelho. Após a intervenção, no WOMAC, apenas os grupos TFOV e TFB apresentaram diminuições significativas na dor (p=0,0358 e p=0,0044, respectivamente), nos demais domínios, o único grupo que apresentou diminuições significativas de escore foi o TFOV (rigidez: p=0,0167 e funcionalidade p=0,0358). Nos testes de funcionalidade, os grupos TFOV e TFA apresentaram aumentos significativos no desempenho do \"Timed-stands test\" (p=0,0251 e p=0,003), no \"Timed-up-and-go\" não foram encontradas melhoras significantes nos grupos. Com relação a força, apenas os grupos TFOV e TFA aumentaram significativamente os valores no leg-press (p<0,0001) e na extensão de joelhos (p<0,0001). Comportamento similar foi encontrado no aumento da AST, grupos TFOV e TFA apresentaram aumentos significativos (p<0,0001). A melhora de qualidade de vida foi significante nos três grupos quando analisamos a somatória dos domínios do WOMAC (TFOV: p=0,0173; TFA: p=0,0438; TFB: p=0,0301), porém o SF-36 não foi capaz encontrar melhoras significativas nos grupos. Dessa forma, concluímos que o TFOV apresenta-se como uma estratégia relevante e segura de intervenção não farmacológica para mulheres acometidas por OA sintomática de joelhos, constituindo um modelo de tratamento capaz de induzir adaptações funcionais e morfológicas de grande interesse para esta população / Osteoarthritis (OA) of the knee is one of the most common articular disease worldwide, affecting 100,000 women in 2693 and 1770 in every 100,000 men. Although strength training (ST) is widely recommended for improving the physical weaknesses found in patients with OA, using loads between 70-85% of maximal dynamic strength (MDS) can be limited not only by pain, but also by the own etiology of the disease, representing a limitation of this practice. Strength training associated with vascular occlusion (STVO) is based on the execution of the ST at intensities between 20 and 50% of MDS, combined with the occlusion of blood flow through the use of tourniquets. Studies have shown that the magnitude of changes in strength and muscle mass after a period of training this technique is similar to those caused by high-intensity ST (MDS 70-85%) without the addition of the vascular occlusion. The objective of this study was to investigate the efficacy of the combination of vascular occlusion to the ST as non pharmacologic intervention model for improving pain, muscle strength, functionality and quality of life in patients diagnosed with knee OA. Thus, 48 women participants were randomly divided into three groups: strength training low intensity (STL), strength training, high intensity (STH) or low-intensity strength training associated with vascular occlusion (STVO) and trained two times per week for twelve weeks. At baseline and after the intervention, the patients underwent physical assessments (tests of functionality and strength), answered questionnaires on quality of life and pain (WOMAC index \"Western Ontario and McMaster Universities Osteoarthritis Index\" and SF-36 \"The Short form 36 Health Survey \") and the cross section area (CSA) of the quadriceps muscle was assessed using computed tomography. During the training period the STH group, four patients were excluded from the protocol due to knee pain. After the intervention, the WOMAC, only the STVO and STL groups showed significant decreases in pain (p=0.0358 and p=0.0044, respectively), in other domains, the only group that showed significant decreases in score was the STVO (stiffness: p= 0.0167 and p = 0.0358 functionality). In functionality testing, the STVO and STH groups showed significant increases in performance \"Timed-stands test\" (p=0.0251 and p=0.003), the \"Timed-up-and-go\" were not significant improvements found in groups. Regarding strength, only the STVO and STH groups significantly increased values in leg press (p<0.0001) and knee extension (p<0.0001). Similar behavior was found in increased AST and STH STVO groups showed significant increases (p<0.0001). The improvement of quality of life was significant in all three groups when analyzing the sum of the domains of WOMAC (STVO: p=0.0173; STH: p=0.0438; STL: p=0.0301), but the SF-36 was not able to find significant improvements in groups. Thus, we conclude that the STVO presents itself as a relevant and safe strategy of non-pharmacological intervention for women suffering from symptomatic knee OA, constituting a model of treatment capable of inducing functional and morphological adaptations of great interest to this population

Tittle:Influence of drugs from the group SYSADOA for knee osteoarthrosis Objectives:The aim of the thesis is to evaluate the effect of three months use of drugs from the group SASADOA on subjective perception of the difficulties associated with knee osteoarthritis and to determine the intensity of gonarthrosis progression in connection with knee cartilage width. Methods:For the study18 probands were obtained from rehabilitation and orthopedic institutions in Prague. The criterion for recruitmen t was knee joint osteoarthrosis of II. degree. For all participants there was conducted input kinesiology analysis and clinical examination, patient's medical history and filled in WOMAC questionnaire. All participants were sent for an X-ray of the knee. Group of probands was randomly divided into two groups. An experimental group was taking Proenzi 3 plus, a control group was taking placebo. Both groups were taking medications for 12 weeks. After this time the probands arrived to check- up and second filling in of the WOMAC questionnaire. The experimental group that had been taking Proenzi 3 plus received placebo for additional 12 weeks, the control group received Proenzi 3 Plus. After finishing preparations all probands were invited to the last visit where they underwent follow-up examination, the third...

Title: The influence of pharmacological substances from the SYSADOA group on knee osteoarthritis. Objectives: The aim of this work is to determine the effect of three - month usage of pharmacological substances from the SYSADOA group on the subjective perception of the difficulties associated with the knee osteoarthritis and on the reological changes in the joint. Methods: In collaboration with rehabilitation and orthopedic centres 18 probands with knee osteoarthritis in the second degree were obtained. These probands were divided into two groups - the experimetal group (including those who have taken Proenzi 3 plus) and the control group (including those who have taken placebo). With all the pacients the input clinical examination and the medical history were done. Probands had been using these preparations for twelve weeks. After this time, the changes in the subjective perception using the WOMAC test and reological changes in the joint were evaluated, using a special knee rheometer. Results: The results of objectively measured parameters clearly proved that the Proenzi 3 plus has a positive effect on the rheological properties of the knee osteoarthritis. The experimental group had a statistically significant improvement in both of these parameters, as opposed to the control group. Concerning...

Die vorliegende retrospektive Analyse zeigt große Unterschiede zwischen frühem (≤ 36 Monate) und spätem (>36 Monate) Knieendoprothesenversagen. Die Indikation für einen Prothesenwechsel in der Gruppe der Frühversager besteht am häufigsten aufgrund einer Malrotation / Malposition der Prothesenkomponenten. Ein Versagen unabhängig von der Standzeit ist meist auf aseptische Prothesenlockerungen zurückzuführen.  Mehrfach operierte Patienten erzielen ein schlechteres Revisonsergebnis und müssen im Mittel nach 34 Monaten einem erneuten Eingriff unterzogen werden. Dies spiegelt sich in schlechteren Befragungsresultaten dieser Patientengruppe wider. Als signifikant erweisen sich die Unterschiede in der körperlichen Aktivität (p=0,041) und im Gesamtscore des WOMAC (p=0,030). Auch Frauen und Patienten mit einem höheren BMI bewerten ihre Situation schlechter, hier zeigen sich signifikante Unterschiede in der Gelenksteifigkeit. Ein höheres Patientenalter wirkt sich dagegen positiv auf das Resultat nach Revisionsoperation aus. Insgesamt bewerten 78% der Befragten ihren Revisionsentscheid im Nachhinein als positiv.

Among other factors, optimism has been shown to significantly influence the course of some diseases (cancer, HIV, coronary heart disease). This study investigated whether optimism of a patient before a total hip replacement can predict the functionality of the lower limbs 3 and 6 months after surgery. A total of 325 patients took part in the study (age: 58.7 years; w: 55%). The functionality was measured with the Western Ontario and McMaster Universities arthrosis index, and optimism with the Life Orientation Test. To analyse the influences of age, gender and optimism, general linear models were calculated. In optimistic patients, functionality improved significantly over time. The study showed a clear influence of dispositional optimism on the recovery after total hip replacement in the first 3 months after surgery.

Title: The evaluation of surgical treatment of the hip in the diagnosis of femor- acetabular impingement syndrome. Objectives: The main objective of this work is to evaluate the effect of the surgery of the hip in diagnosis of femor-acetabular hip impingement. Methods: In our work we have cooperated with 103 patients who have been operated on hip with the diagnosis of femor-acetabular hip impingement (FAI). We used standardized questionnaires of WOMAC and NAHS, which assesses functional self- care, limitations in motion and painfulness. Patients completed questionnaires twice. For the first time before surgery and second time at least one year after the surgery. The specimens of questionnaire are attached in the Annex. Results: We found out that postoperative condition is significantly different from the preoperative state in terms of improved self-care, increased range of motion and reduction of painfulness. Keywords: Femor-acetabular impingement, hip surgery, WOMAC, NAHS

Osteoarthritis is a common degenerative disorder that affects joints. Despite recent therapeutic advances, osteoarthritis continues to be a challenging health problem, and elderly population is particularly at risk. Pain is the most unbearable symptom experienced by osteoarthritic patients. Currently, several pharmacological medications are available to manage osteoarthritic pain. Opioids, potent analgesics, have shown extraordinary ability to reduce intense pain in many osteoarthritic clinical trials. Although many clinical trials have investigated the efficacy and safety of opioids in osteoarthritic patients, there is an increased need for a study to integrate the reported outcomes and utilize them to achieve a better understanding of efficacy and safety profiles of opioids. Therefore, in our present study, efficacy, safety, and tolerability profiles of opioid compounds used to manage osteoarthritic pain were assessed and compared using a model-based meta-analysis (MBMA). To achieve our goal, a comprehensive database consisting of pain relief compounds with information on summary-level of efficacy over time, adverse events and dropout rates was compiled from multiple sources. MBMA was conducted using nonlinear mixed-effects modeling approach. The results showed that the selected models successfully captured the observed data, and primary efficacy endpoint estimations indicated that the ED50 of oxycodone, oxymorphone, and tramadol were 47, 84, and 247 mg per day, respectively. Efficacy-time course analysis showed that opioids had rapid time to efficacy onset, suggesting potential powerful pain relief effects. Also, it was found that gastrointestinal adverse events were the most opioid-associated and dose-dependent adverse effects. In addition, the analysis revealed that opioids are well-tolerable at low to moderate doses. The results presented here provided clinically meaningful insights into the efficacy and safety of oxycodone, oxymorphone, and tramadol. In addition, the presented framework analysis has a clinical impact on drug development where it can help in optimizing the dose of opioids to manage osteoarthritic pain, making precise key decisions for positioning of new drugs, and designing more efficient clinical trials.

Zusammenfassung: Einleitung: Die primäre Koxarthrose wird bei vielen Patienten jährlich als Diagnose gesichert, verursacht jedoch hohe Kosten im deutschen Gesundheitssystem. Lassen sich überhaupt noch kostendeckende Erlöse unter Realisation hervorragender, qualitätsorientierter und medizinischer Versorgung der Patienten erzielen? Ergibt sich dennoch eine messbare Verbesserung der Lebensqualität im Rahmen eines prospektiven Vergleichs? Welche Faktoren tragen zu einem positiven Deckungsbeitrag bei? Patienten und Methodik: Prospektive Studie zu 100 Patienten mit primärer Hüft-TEP-Implantation bei Grunderkrankungsbild einer primären Koxarthrose. Erstellung einer IST-Kosten-Analyse im universitären Sektor mithilfe der InEK-Kostenmatrix und gleichzeitiger Erhebung aller gesetzlich erforderlichen Qualitätsindikatoren. Zusätzlich durchgeführte WOMAC-Befragung (Stucki et al. 2006) in der präoperativen als auch postoperativen Kliniksituation. Ergebnis: Wirtschaftlich kostendeckendes Ergebnis mit durchschnittlich 1.245,73 Euro pro Patientenfall in der abzurechnenden DRG I47B. Basis-DRG I47 erwies sich grundsätzlich als gewinnbringend im Kliniksektor auch unter Beachtung des DRG-Katalogeffektes 2016 zu 2017 mit einer deutlichen Abwertung um 0,218 Bewertungsrelationen. Die Lebensqualität hat sich in 97% der Patientenfälle deutlich verbessert. Sowohl Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Globalindex als auch die 3 Subskalen – Schmerz, Steifigkeit und Verrichtung von Alltagsaktivitäten- spiegeln eine erhebliche Zunahme der Lebensqualität wider. Die erhobenen Qualitätsindikatoren liegen in den gesetzlich definierten Referenzbereichen. Die Mortalitätsrate beträgt 0%. Schlussfolgerung: Trotz derzeit ermittelter Kostendeckung zeigt sich ein zunehmender Kostendruck durch das gesundheitspolitische System. Die aktuelle gesundheitswirtschaftliche Entwicklung lässt einen negativen Katalogeffekt durch InEK weiterhin erwarten. Der demographische Wandel in Deutschland erzeugt auch die Zunahme der Versorgung von älteren Patienten im Bereich der Endoprothetik in Deutschland. Der Maßstab für eine qualitätsorientierte und medizinisch-leitgerechte Patientenbehandlung erzeugt liegt sehr hoch.:Inhaltsverzeichnis Abbildungsverzeichnis ....................................................................................................... V Tabellenverzeichnis .......................................................................................................... VII Abkürzungsverzeichnis ................................................................................................... VIII 1 Einführung ................................................................................................................ 1 1.1 Klinische Grundlagen ................................................................................................. 2 1.1.1 Funktionell-anatomische Erläuterung des Erkrankungsbildes primäre Koxarthrose ... 2 1.1.2 Historische Entwicklung der Hüftendoprothetik .......................................................... 5 1.1.3 Qualitätssicherung im Bereich der Hüftendoprothetik ................................................. 5 1.2 Gesundheitsökonomische Grundlagen ...................................................................... 8 1.2.1 Bedeutung des DRG-System ..................................................................................... 8 1.2.2 Kennzahlen im DRG-System ..................................................................................... 9 1.2.3 Kostenkalkulation einer DRG im Überblick ................................................................12 2 Ziel der Arbeit ..........................................................................................................19 3 Material und Methoden ...........................................................................................21 3.1 Klinische Erhebungen ...............................................................................................21 3.1.1 Erhebung WOMAC-Score .........................................................................................21 3.1.2 Befragung im Untersuchungsmodus .........................................................................22 3.1.3 Patientenbefragung zu Qualitätsindikatoren ..............................................................22 3.2 Gesundheitsökonomische Erhebungen .....................................................................23 3.2.1 Erhebung einzelner betriebswirtschaftlicher Kennzahlen ..........................................23 3.2.2 Ermittlung der verschiedenen Kostenarten analog InEK-Matrix .................................24 3.3 Anwendung und Nutzung Software ...........................................................................26 4 Ergebnisse ..............................................................................................................27 4.1. Klinische Ergebnisse .................................................................................................27 4.1.1 Epidemiologische Daten ...........................................................................................27 4.1.2 Klinische Ergebnisse aus der Erhebung des WOMAC -Score ...................................29 4.1.3 Klinische Ergebnisse zu den erhobenen Qualitätsindikatoren ...................................36 4.2 Gesundheitsökonomische Ergebnisse ......................................................................41 4.2.1 Ergebnisse zu den erhobenen betriebswirtschaftlichen Kennzahlen .........................41 4.2.2 Ergebnisse der DRG-Kostenberechnung analog zur InEK-Matrix .............................45 5 Diskussion ...............................................................................................................49 6 Zusammenfassung der Arbeit ................................................................................60 7 Literaturverzeichnis ................................................................................................. X 8 Glossar ................................................................................................................... XV