Management des Protheseninfektes

Abstract

Periprosthetic infection is a permanent risk and severe complication in joint arthroplasty. Systematic diagnostics under optimal conditions are necessary for a successful therapy. Patient history, clinical examination and an elevated CRP-level is the basis for suspicion of infection. The diagnosis is confirmed by identification of the pathogen from a sample collected through joint aspiration under sterile conditions. The microbiological examination is done in a laboratory specialized in the diagnosis of foreign body infections. The pattern of resistance of the identified pathogen determines the topical and systemic course of antibiotics. Surgical treatment is characterized by exchange of the prosthesis and radical debridement. The exchange can be carried out in one or two stages. The one-stage exchange offers several advantages compared to two or more stage procedures for all those involved - patient, surgeon and health care system - while providing the same chance of successful elimination of infection, with even better functional results.

Two-stage revision of implant-associated infections after total hip and knee arthroplasty

“…The diagnosis “periprosthetic infection” may be clear when purulent secretion and signs of septicaemia are apparent. But in cases of suspected septic loosening the preoperative laboratory and puncture fail to identify bacterial colonization in up to 20% of all cases [15], [20], [24], [25]. A mini-incision biopsy (e.g.…”

“…® , KCI Wiesbaden, Germany) combined with a suction/irrigation system [32], [33]. But due to the limited success rates of 50% to 60% [15], [32] the vacuum assisted closure therapy remains an option for isolated cases [13], [34]. …”

“…One-stage as well as two-stage revisions have been reported to be successful in 80% to 100% [3], [15], [18], [35], [36]. One-stage concepts are described to be advantageous concerning duration of hospitalization, functional outcome, and economic aspects [15], [18], [24], [37].…”

“…As opposed to this, the question how “late infections” should be treated is still undecided and lively discussed in the literature [3], [10], [12], [15], [16], [17], [18]. But there is a consensus that basically a treatment algorithm should be established for medical, economical and forensic reasons [16].…”

Titanium-copper-nitride coated spacers for two-stage revision of infected total hip endoprostheses

“…The addition of antibiotics to bone cement is also practiced in conjunction with one-stage septic revisions when a cemented implant is used and the bacterial antibiogram is known [15]. Additional mixing of antibiotics into bone cement intraoperatively reduces the mechanical resilience of the cement [7], [8] which may lead to breakage of the spacer [16] or cement mantle around endoprostheses.…”