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.

Keywords: Comprehensive geriatric assessment (CGA); Elderly patients; Frailty; Geriatric; Multiprofessional care; Orthogeriatric; Orthogeriatric co-management (OGC); Perioperative Care of Older Persons (POPS); Total hip arthroplasty (THA); Total knee arthroplasty (TKA).

Fig. 1

Standard Protocol Items Recommendations for Interventional Trials (SPIRIT) Schedule of enrolment, interventions, and assessments. SPPB: Short Physical Performance Battery, ADL: Activities of Daily Living, IADL: Instrumental Activities of Daily Living, MMSE: Mini-Mental State Examination, GDS: Geriatric Depression Scale, NRS: Nutritional Risk Screening, NU-DESC: Nursing Delirium Screening Scale, PROM: Patient Reported Outcome Measurement, WOMAC: Western Ontario and McMaster Universities Osteoarthritis Index, EQ-5D: Euroquol Quality of Life Index, PREM: Patient Reported Experience Measurement, PPP33: Perioperative Patient Questionnaire, ISAR: Identification of Seniors at Risk, SOG: Special Orthopaedic Geriatrics

Fig. 2

Study intervention and outcome assessments