Wiener klinische Wochenschrift

, Volume 123, Issue 7–8, pp 191–197 | Cite as

Current concepts review: Septic arthritis of the knee pathophysiology, diagnostics, and therapy

  • Atesch Ateschrang
  • Dirk Albrecht
  • Steffen Schroeter
  • Kuno Weise
  • Jürgen Dolderer
Review Article

Summary

Treatments for bacterial arthritis of the knee joint are arthroscopic irrigation and debridement with systemic antibiotic medication. This article summarizes the relevant data of pathophysiology, stage of infection, symptoms, and diagnostics as well as stage-dependent treatment of bacterial arthritis of the knee joint. The major treatment principles are joint decompression, elimination of the causative organisms by intensive irrigation of the joint with elimination of proteolytic and lysosomal enzymes. Debridement of necrotic soft tissues with the aim of preserving the synovial membrane as an immune-competent structure, and a natural barrier, is recommended. Good results in treating knee infections have been achieved with arthroscopic joint revision and stage-dependent surgical therapy. The infection staging I–IV suggested by Gächter was used most commonly, which mainly reflects the pathophysiologic infection stages. For stages I–III, arthroscopic joint decompression with joint irrigation and debridement is effective and can be repeated in cases of persisting infection. The incidence of repeated arthroscopic joint irrigation depends on the initial stage of the infection and varies between 0 and 41% of the cases. For stage IV infections, the open revision is needed or in seldom cases of therapy failure under initial or repeated arthroscopic joint revision. The success rate of healing infections by arthroscopic irrigation was high with 90–100%.

Keywords

Bacterial arthritis Knee joint infection Stages of infection Arthroscopy 

Übersicht: Behandlungskonzepte der bakteriellen Kniegelenksinfektion Pathophysiologie, Diagnostik, und Therapie

Zusammenfassung

Die Behandlung der bakteriellen Kniegelenksinfektion erfolgt durch die arthroskopische Revision mit Spülung und Debridement sowie systemischer Gabe von Antibiotika. Dieser Artikel fasst die relevanten Untersuchungen zu Pathophysiologie, Infektklassifikation, klinischen Symptome mit dazugehöriger Diagnostik und stadiengerechter Therapie der Kniegelenksinfektion zusammen. Die wichtigsten Behandlungsprinzipien sind die Gelenkdekompression mit Eliminierung der Bakterien sowie proteolytischer und lysosomaler Enzyme durch eine intensive Gelenkspülung. Das Debridement sollte auf nekrotische synoviale und periartikuläte Strukturen begrenzt bleiben mit der Zielsetzung die Synovia als natürliche Barriere und immunkompetentes Organ zu erhalten. Gute Ausheilungsergebnisse konnten durch die arthroskopische Spülung mit Debridement bei stadiengerechter Therapie erzielt werden. Die Infektklassifikation nach Gächter mit den Stadien I–IV wurde dabei am häufigsten genutzt, wobei diese die pathophysiologischen Stadien widerspiegelt. Für die Infektstadien I–III ist die arthroskopische Gelenkrevision mit Spülung und Debridement effektiv, die bei persistierendem Infektgeschehen auch wiederholt werden kann. Die Häufigkeit der wiederholten arthroskopischen Spülung hängt von dem primären Infektstadium ab und schwankt zwischen 0 und 41% der Fälle. Für das Infektstadium IV nach Gächter sowie für persisitierende Infektionen trotz mehrfacher arthroskopischer Spülung weniger schwerer Infektstadien (I–III) wird die offene Gelenkrevision empfohlen. Die Ausheilungsrate der Kniegelenksinfektionen durch die arthroskopische Revision liegt derzeit bei 90 bis 100 %.

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Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Atesch Ateschrang
    • 1
  • Dirk Albrecht
    • 1
  • Steffen Schroeter
    • 1
  • Kuno Weise
    • 1
  • Jürgen Dolderer
    • 1
  1. 1.Berufsgenossenschaftliche Unfallklinik TübingenGermany

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