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Что рекомендуют профессиональные общества и с какой силой
« Справка о документе не заменяет самого документа »
Документов
10
Положений
143
С сильной рекомендацией
48
Текст скрыт лицензией
37
показаны ссылка и сила
Организаций
3
Почему часть текстов не показана
Объём показа решает лицензия документа, а не редактор. NICE разрешает повторное использование только в пределах Великобритании — система работает из Украины, поэтому текст положений NICE не показывается вовсе. У AAOS «all rights reserved» — короткая выдержка со ссылкой.
Причина выбранного режима хранится вместе с документом, и её видно в таблице ниже.
Документы
| Документ | Год | Страна | Положений | Режим показа | Причина |
|---|---|---|---|---|---|
| AAOS · Management of Osteoarthritis of the Hip: Evidence-Based Clini… | 2023 | США | 17 | выдержка | «all rights reserved»: перепубликация запрещена, показывается короткая выдержка с обязательной ссылкой на первоисточник |
| AAOS · Surgical Management of Osteoarthritis of the Knee: Evidence-B… | 2022 | США | 16 | выдержка | «all rights reserved»: перепубликация запрещена, показывается короткая выдержка с обязательной ссылкой на первоисточник |
| AAOS · Management of Osteoarthritis of the Knee (Non-Arthroplasty):… | 2021 | США | 28 | выдержка | «all rights reserved»: перепубликация запрещена, показывается короткая выдержка с обязательной ссылкой на первоисточник |
| AAOS · Management of Hip Fractures in Older Adults: Evidence-Based C… | 2021 | США | 16 | выдержка | «all rights reserved»: перепубликация запрещена, показывается короткая выдержка с обязательной ссылкой на первоисточник |
| AAOS · Diagnosis and Prevention of Periprosthetic Joint Infections:… | 2019 | США | 18 | выдержка | «all rights reserved»: перепубликация запрещена, показывается короткая выдержка с обязательной ссылкой на первоисточник |
| AAOS · Preventing Venous Thromboembolic Disease in Patients Undergoi… | 2011 | США | 11 | выдержка | «all rights reserved»: перепубликация запрещена, показывается короткая выдержка с обязательной ссылкой на первоисточник |
| ICM · ICM-VTE: International Consensus Meeting on Venous Thromboemb… | 2022 | международный | 6 | только ссылка | условия использования не установлены; умолчание движка лицензий — запрет, поэтому показывается только ссылка |
| ICM · 2018 International Consensus Meeting on Musculoskeletal Infec… | 2018 | международный | 3 | только ссылка | условия использования не установлены; умолчание движка лицензий — запрет, поэтому показывается только ссылка |
| NICE · Joint replacement (primary): hip, knee and shoulder (NG157) | 2020 | UK | 22 | только ссылка | повторное использование разрешено только в пределах Великобритании; система работает из страны UA, поэтому текст положения не показывается… |
| NICE · Fractures (non-complex): assessment and management (NG38) | 2016 | UK | 6 | только ссылка | повторное использование разрешено только в пределах Великобритании; система работает из страны UA, поэтому текст положения не показывается… |
Эндопротезирование — 35
Tranexamic acid (TXA) should be considered for patients with symptomatic osteoarthritis of the hip who are undergoing total hip arthroplasty (THA) to reduce blood loss and the need for blood transfusions.
In patients with no known contraindications, tranexamic acid (TXA) should be used because its use decreases postoperative blood loss, postoperative drain collection, and reduces the necessity of postoperative…
There is no difference in postoperative functional scores between patients with a BMI < 30 and obese patients (BMI 30-39.9); however, there may be increased risk of complications in morbidly obese patients (≥40), in…
Optimization of perioperative glucose control (<126mg/dl) after total knee arthroplasty should be attempted in diabetic and non-diabetic patients with HgbA1C <6.5, as hyperglycemia can lead to less favorable…
Evidence reports that there is no difference in outcomes, function, pain, or blood transfusions between the use of tourniquets and nonuse of tourniquets.
Evidence reports that there is no difference between patellar surfacing or nonpatellar resurfacing in total knee arthroplasty.
Cruciate retaining (CR) and posterior stabilized (PS) total knee arthroplasty (TKA) designs have similarly efficacious/favorable postoperative outcomes.
The practitioner should not use patient specific technology (e.g., guides, cutting blocks) because there is no significant difference in patient outcomes, function, or pain as compared to conventional total knee…
There is no difference in composite/functional outcomes or complications between kinematic or mechanical alignment principles in total knee arthroplasty.
In older adult patients undergoing total hip arthroplasty for symptomatic osteoarthritis, cemented femoral stems could be considered as they are associated with a lower risk of periprosthetic fracture.
There are specific risks and benefits to each surgical approach and there is not a preferred surgical approach for patients with symptomatic osteoarthritis of the hip undergoing total hip arthroplasty.
Elevated BMI may increase the risk of adverse events in patients undergoing total hip arthroplasty for symptomatic hip osteoarthritis.
Остеоартроз — 27
Intraarticular hyaluronic acid should not be considered for treatment of symptomatic osteoarthritis of the hip as it does not improve function or reduce pain better than placebo.
When not contraindicated, oral nonsteroidal anti-inflammatories (NSAIDs) should be used to reduce pain and improve function in the treatment of symptomatic hip osteoarthritis.
Lateral wedge insoles are not recommended for patients with knee osteoarthritis.
Topical NSAIDs should be used to improve function and quality of life for treatment of osteoarthritis of the knee, when not contraindicated.
Oral NSAIDs are recommended to improve pain and function in the treatment of knee osteoarthritis when not contraindicated.
Oral acetaminophen is recommended to improve pain and function in the treatment of knee osteoarthritis when not contraindicated.
Oral narcotics, including tramadol, result in a significant increase of adverse events and are not effective at improving pain or function for treatment of osteoarthritis of the knee.
Intraarticular corticosteroids could be considered to improve function and reduce pain in the short-term for patients with symptomatic osteoarthritis of the hip.
Oral opioids not be utilized for nonoperative treatment of symptomatic osteoarthritis of the hip.
When not contraindicated, oral acetaminophen may be considered to improve pain and function in the treatment of symptomatic osteoarthritis of the hip.
Canes could be used to improve pain and function in patients with knee osteoarthritis.
Brace treatment could be used to improve function, pain and quality of life in patients with knee osteoarthritis.
Инфекция — 21
Strong evidence supports the use of the following to aid in the preoperative diagnosis of prosthetic joint infection (PJI): Serum erythrocyte sedimentation rate (ESR), Serum C-reactive protein (CRP), Serum interleukin-6.
Strong evidence supports the use of histopathology to aid in the diagnosis of PJI.
Strong evidence supports that preoperative prophylactic antibiotics be given prior to revision surgery in patients at low preoperative suspicion for periprosthetic infection and those with an established diagnosis of…
Текст положения не показан: лицензия документа этого не разрешает. Доступны название, сила рекомендации и ссылка.
Moderate strength evidence supports that obesity is associated with increased risk of PJI.
Limited evidence suggests intra-articular injection performed prior to total joint arthroplasty may have a time-dependent association for increased risk of PJI.
Moderate strength evidence does not support the clinical utility of the following to aid in the diagnosis of PJI: Peripheral blood leukocyte count, Serum tumor necrosis factor-α.
Moderate strength evidence supports the use of the following to aid in the diagnosis of prosthetic joint infection (PJI): Synovial fluid leukocyte count and neutrophil percentage, Synovial fluid aerobic and anaerobic…
Moderate strength evidence supports the use of the following to aid in the diagnosis of prosthetic joint infection (PJI): Multiple aerobic and anaerobic bacterial periprosthetic tissue cultures, Implant sonication fluid…
Limited strength evidence supports that periprosthetic tissue nucleic acid amplification testing for bacteria is not useful in the diagnosis of PJI.
Moderate strength evidence supports that the practitioner avoid the use of intraoperative gram stain to rule out periprosthetic joint infection.
Limited evidence supports withholding antimicrobials for a minimum of two weeks prior to obtaining intra-articular culture to establish the diagnosis of PJI.
Переломы — 17
Preoperative traction should not routinely be used for patients with a hip fracture.
In patients with unstable (displaced) femoral neck fractures, arthroplasty is recommended over fixation.
In patients undergoing arthroplasty for femoral neck fractures, the use of cemented femoral stems is recommended.
In patients with stable intertrochanteric fractures, use of either a sliding hip screw or a cephalomedullary device is recommended.
In patients with subtrochanteric or reverse obliquity fractures a cephalomedullary device is recommended.
Patients with unstable intertrochanteric fractures should be treated with a cephalomedullary device.
Tranexamic acid should be administered to reduce blood loss and blood transfusion in patients with hip fractures.
Hip fracture surgery within 24-48 hours of admission may be associated with better outcomes.
In patients with unstable (displaced) femoral neck fractures, unipolar or bipolar hemiarthroplasty can be equally beneficial.
In properly selected patients with unstable (displaced) femoral neck fractures, there may be a functional benefit to total hip arthroplasty over hemi arthroplasty at the risk of increasing complications.
In patients undergoing treatment of femoral neck fractures with hip arthroplasty, evidence does not show a favored surgical approach.
A blood transfusion threshold of no higher than 8g/dl is suggested in asymptomatic postoperative hip fracture patients.
Тромбопрофилактика — 17
Venous thromboembolism (VTE) prophylaxis should be used in hip fracture patients.
We recommend against routine post-operative duplex ultrasonography screening [of patients who undergo elective hip or knee arthroplasty].
Текст положения не показан: лицензия документа этого не разрешает. Доступны название, сила рекомендации и ссылка.
Текст положения не показан: лицензия документа этого не разрешает. Доступны название, сила рекомендации и ссылка.
The practitioner might further assess the risk of venous thromboembolism by determining whether these patients had a previous venous thromboembolism.
We suggest that patients discontinue antiplatelet agents [before elective hip or knee arthroplasty].
We suggest the use of pharmacologic agents and/or mechanical compressive devices [for the prevention of venous thromboembolism in patients not at elevated risk beyond that of the surgery itself].
[It is the opinion of the work group that] patients and physicians discuss the duration of prophylaxis.
[It is the opinion of the work group that] patients undergo early mobilization following elective hip and knee arthroplasty.
We are unable to recommend for or against the use [of inferior vena cava filters in patients with a contraindication to chemoprophylaxis].
Patients with a previous venous thromboembolism should receive pharmacologic prophylaxis and mechanical compressive devices.
Patients with known bleeding disorders and/or active liver disease should use mechanical compressive devices.
Реабилитация — 14
Supervised exercise, unsupervised exercise, and/or aquatic exercise are recommended over no exercise to improve pain and function for treatment of knee osteoarthritis.
Self-management programs are recommended to improve pain and function for patients with knee osteoarthritis.
Patient education programs are recommended to improve pain in patients with knee osteoarthritis.
Interdisciplinary care programs should be used in the care of hip fracture patients to decrease complications and improve outcomes.
Either formal physical therapy or unsupervised home exercise after total hip arthroplasty for symptomatic osteoarthritis of the hip.
Physical therapy could be considered as a treatment for patients with mild to moderate symptomatic osteoarthritis of the hip to improve function and reduce pain.
Neuromuscular training (i.e. balance, agility, coordination) programs in combination with traditional exercise could be used to improve performance-based function and walking speed for treatment of knee osteoarthritis.
Manual therapy in addition to an exercise program may be used to improve pain and function in patients with knee osteoarthritis.
Massage may be used in addition to usual care to improve pain and function in patients with knee osteoarthritis.
Текст положения не показан: лицензия документа этого не разрешает. Доступны название, сила рекомендации и ссылка.
Текст положения не показан: лицензия документа этого не разрешает. Доступны название, сила рекомендации и ссылка.
Текст положения не показан: лицензия документа этого не разрешает. Доступны название, сила рекомендации и ссылка.
Анестезия — 9
Peripheral nerve blockades for total knee arthroplasty lead to decreased postoperative pain and opioid requirements with no difference in complications or outcomes.
Periarticular injections used in total knee arthroplasty lead to decreased postoperative pain and opioid requirements.
Either spinal or general anesthesia is appropriate for patients with a hip fracture.
Multimodal analgesia incorporating preoperative nerve block is recommended to treat pain after hip fracture.
Neuraxial anesthesia may be used to reduce adverse events in patients with symptomatic osteoarthritis of the hip undergoing total hip arthroplasty.
We suggest the use of neuraxial anesthesia [to help limit blood loss].
Текст положения не показан: лицензия документа этого не разрешает. Доступны название, сила рекомендации и ссылка.
Текст положения не показан: лицензия документа этого не разрешает. Доступны название, сила рекомендации и ссылка.
Текст положения не показан: лицензия документа этого не разрешает. Доступны название, сила рекомендации и ссылка.
Визуализация — 3
Limited strength evidence supports the use of the following to aid in the diagnosis of PJI: 18F-FDG PET/CT, 18F-NaF PET/CT, CT.
Limited strength evidence supports the clinical utility of nuclear imaging to aid in the diagnosis of PJI.
Текст положения не показан: лицензия документа этого не разрешает. Доступны название, сила рекомендации и ссылка.
Профессиональный справочно-аналитический инструмент для специалистов здравоохранения. Не предназначен для диагностики, профилактики, мониторинга, предсказания, прогнозирования или лечения заболеваний у конкретного пациента. Не является медицинским изделием.
Приведённые положения — справка о содержании документов, а не их замена и не рекомендация в отношении конкретного пациента. Решение принимает врач по первоисточнику.