Diagnose und Therapie periprothetischer Infektionen

Lenz, Mark; Hofmann, G. O.; Mückley, Thomas

doi:10.1007/s00113-012-2189-9

Cited by 5 publications

(4 citation statements)

References 20 publications

(21 reference statements)

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“…Statistical analysis was performed using the spreadsheet software Microsoft Excel (Microsoft Corporation, Redmond, USA). The diagnosis of periprosthetic infection was determined on the basis of clinical symptoms and signs, e.g., positive mirror sign in addition to laboratory investigations and accepted parameters such as C-reactive protein, leucocytic count, and the isolation of microbes 21 , 22 , 23 , 24 . As a reinfection or recurrence, we defined a clinically and microbiologically recurrence of local periprosthetic joint infections after an antibiotic-free period.…”

Section: Methodsmentioning

confidence: 99%

Management of Modular Mega-Implant Infection of the Lower Extremity

et al. 2021

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Introduction Revision arthroplasty involving mega-implants is associated with a high complication rate. In particular, infection is a serious complication of revision arthroplasty of hip and knee joints and has been reported to have an average rate of 18%, and for mega-implants, the range is from 3 to 36%. This study was designed to analyze the strategy of treatment of infection of mega-endoprostheses of the lower extremities in our patient cohort, particularly the management of chronic infection. Material and Methods This was a retrospective study that focused on the results of the treatment of periprosthetic infections of mega-implants of the lower extremities. We identified 26 cases with periprosthetic infections out of 212 patients with 220 modular mega-endoprostheses of the lower extremities who were treated in our department between September 2013 and September 2019. As a reinfection or recurrence, we defined clinical and microbiological recurrences of local periprosthetic joint infections after an antibiotic-free period. Results In this study, 200 cases out of 220 were investigated. The average follow-up period was approximately 18 months (6 months to 6 years). Endoprosthesis infections after implantation of mega-implants occurred in 26 cases (13%). This group comprised 2 early infections (within the first 4 weeks) and 24 chronic infections (between 10 weeks and 6 years after implantation). Nineteen cases out of the identified 26 cases with infection (73.1%) belong to the group of patients who were operated on due to major bone loss following explantation of endoprosthetic components due to previous periprosthetic joint infection. The remaining seven cases with infection comprised four cases following management of periprosthetic fracture, two cases following treatment of aseptic loosening, and one case following tumor resection. All infections were treated surgically. In all cases, the duration of continuous antibiotic treatment did not exceed 6 weeks. Both cases with early infection were treated by exchanging polyethylene inlays and performing debridement with lavage (two cases). In two (7.7%) cases with chronic infection, one-stage surgery was performed. In all remaining cases with chronic infection (22 cases; 84.6%), explantation of all components and temporary implantation of cement spacers were carried out prior to reimplantation. Conclusion There is still no gold standard therapeutic regimen for the management of periprosthetic infection of mega-implants, though radical surgical debridement and lavage accompanied by systemic antibiotic therapy are the most important therapeutic tools in all cases of periprosthetic infections, regardless of the time of onset. Further studies are needed to standardize management strategies of such infections. Nevertheless, it is not uncommon for compromises to be made based on the particular condition of the individual.

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Section: Methodsmentioning

confidence: 99%

Management of Modular Mega-Implant Infection of the Lower Extremity

et al. 2021

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“…Mehr als eine Probe (meist 3 empfohlen) von verschiedenen betroffenen Regionen des Knochens zu entnehmen, scheint, wenn dies von der Größe möglich ist, dringend angeraten. Abszessbildung, Leukozyteninfiltrationen sowie das gleichzeitige Vorliegen von Knochennekrosen, osteoklastischem Knochenabbau und reaktiver Knochenneubildung sind typische Befunde der Osteomyelitis [3,14,25,27,29,30]. Im eigenen Patientengut erfolgt die Biopsie zur histologischen Untersuchung regelhaft initial als offenes Verfahren, zusammen mit dem ersten Schritt der Sanierung [12].…”

Section: Mikrobiologie Und Histopathologieunclassified

“…Zweizeitiges Vorgehen 1) Die operative Infektsanierung umfasst das Débridement, die Nekrosektomie, die Resektion von Knochensequestern sowie ggf. Entfernung von Fremdkörpern und Implantaten, um eine Bakterienprotektion durch Biofilm zu vermeiden [1,2,23,25]. Dabei sollte auch die Biopsieentnahme (s.…”

Section: Operative Therapieunclassified

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Osteitis/Osteomyelitis an Hand und Handgelenk

Lautenbach

Tenbrock

Böck

et al. 2021

Handchir Mikrochir Plast Chir

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ZusammenfassungDie Osteomyelitiden im Bereich von Handgelenk und Hand sind weniger häufig als die Knocheninfektionen der langen Röhrenknochen, aber nicht selten. Viele Fragen zur Klassifikation, Pathogenese, Diagnostik, zum Therapiemanagement sowie den erreichbaren Behandlungsergebnissen sind bisher nur wenig ausreichend wissenschaftlich kontrolliert. Die Pathogenese der Erkrankung kann in posttraumatische, postoperative, fortgeleitete und hämatogene Osteomyelitiden, unter Erfassung der patientenindividuellen Risiken, eingeteilt werden. Eine frühe Diagnose und eine adäquate Therapie sind notwendig, um die betroffenen knöchernen Strukturen sowie die Funktion der angrenzenden Gelenke zu erhalten. Ein mehrzeitiges operatives Vorgehen ist dabei häufig notwendig. Zufriedenstellende Raten der Infektionskontrolle und erfolgreiche knöcherne Rekonstruktionen können meist erreicht werden. Komplikationen, verbleibende Defizite und partielle Amputationen, auch bei angemessener Therapie der Osteomyelitiden, sind auf Grund der Schwere der Erkrankung aber nicht immer zu verhindern.

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