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Septischer Endoprothesenwechsel

Präoperative Diagnostik und Reimplantation

Septic endoprosthesis exchange

Preoperative diagnosis and reimplantation

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Zusammenfassung

Hintergrund

Die Behandlung von periprothetischen Infektionen (PPI) ist eine der größten Herausforderungen im Bereich der Endoprothetik. Der PPI stellt neben den physischen und psychosozialen Problemen für den Patienten eine außerordentliche sozioökonomische Herausforderung an unser Gesundheitssystem dar. Gerade die präoperative Diagnostik ist im Hinblick auf neue Behandlungskonzepte und differenzierte Therapien wichtig, um das bestmögliche Ergebnis für den Patienten zu erzielen.

Ziel der Arbeit

Die vorliegende Arbeit gibt eine Übersicht über die präoperative Diagnostik des PPI sowie über die verschiedenen Möglichkeiten beim ein- oder zweizeitigen Endoprothesenwechsel.

Methode

Es wurde eine selektive Literaturrecherche zu Diagnostik und Behandlungskonzepten von PPI durchgeführt.

Ergebnisse

Entscheidend für die Wahl der richtigen Behandlungsoption ist der präoperative Keimnachweis. Eine präoperative Stufendiagnostik mit Gelenkpunktion zur mikrobiologischen und zytologischen Untersuchung stellt den Goldstandard dar. Um den Keimnachweis zu erzwingen, kann eine Biopsie notwendig sein. Je nach Behandlungskonzept sind unterschiedliche Reimplantationszeitpunkte zu unterscheiden. Moderne Behandlungskonzepte ermöglichen eine frühzeitige Reimplantation im kurzen Intervall. Zahlreiche patientenindividuelle Faktoren und Resistenzmuster der auslösenden Keime sind dabei zu berücksichtigen.

Zusammenfassung

PPI stellen neben den physischen und psychosozialen Problemen für den Patienten eine Herausforderung an unser Gesundheitssystem dar. Eine standardisierte präoperative Diagnostik sowie neue Behandlungskonzepte können helfen, das Outcome für den Patienten zu verbessern.

Abstract

Background

The treatment of prosthetic joint infection (PJI) is truly challenging. Patients with infected arthroplasty face physical and psychosocial problems. Furthermore, treatment costs represent a tremendous socioeconomic burden.

Aim

This article presents an overview of the preoperative diagnosis of PJI and one- or two-stage endoprosthetic exchange options.

Method

A selective literature search was performed focusing on diagnostics and innovative surgical treatment concepts in PJI.

Results

The identification of the underlying pathogen is still the main focus in the diagnosis of PJI. State-of-the-art therapy for PJI with mature biofilm consists of implant removal with one- or two-stage exchange arthroplasty. One-stage exchange offers lower morbidity and improved functional outcome, whereas a two-stage procedure is, according to current knowledge, more favourable in terms of infection control. The novel short-term two-stage exchange regimen combines the advantages of both possibilities.

Discussion

Prosthetic joint infection represents a significant challenge for the othopaedic surgeon. Novel treatment options can help to improve outcome and lower the costs to the health care system.

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Authors and Affiliations

  1. Klinik und Poliklinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland

    H.M.L. Mühlhofer, J. Schauwecker, I.J. Banke & R. von Eisenhart-Rothe

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  1. H.M.L. Mühlhofer
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  2. J. Schauwecker
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  3. I.J. Banke
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  4. R. von Eisenhart-Rothe
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Correspondence to H.M.L. Mühlhofer.

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H.M.L. Mühlhofer, J. Schauwecker und R. Eisenhart-Rothe geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Mühlhofer, H., Schauwecker, J., Banke, I. et al. Septischer Endoprothesenwechsel. Orthopäde 44, 946–951 (2015). https://doi.org/10.1007/s00132-015-3191-z

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  • DOI: https://doi.org/10.1007/s00132-015-3191-z

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