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Akute postoperative Infektion nach Duokopfprothesenimplantation beim geriatrischen Patienten

Acute postoperative infections after dual head arthroplasty in geriatric patients

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Zusammenfassung

Akute periprothetische Infektionen (PPI) nach Duokopfprothesen stellen im oftmals multimorbiden, geriatrischen Patientenkollektiv eine besondere Herausforderung mit Einjahresmortalitätsraten bis zu 50 % dar. Für Duokopfprothesen sind Infektionsraten in bis zu 9 % der Fälle beschrieben und liegen damit deutlich höher als in der elektiven Endoprothetik. Ein therapeutischer Goldstandard hat sich aufgrund der heterogenen Studienlage und fehlender prospektiver randomisierter Studien bisher nicht etablieren können. Von den möglichen Therapieverfahren erscheint der einzeitige Schaftwechsel in Kombination mit der Implantation einer Pfannenkomponente derzeit am erfolgversprechendsten (Konversion auf eine Hüfttotalendoprothese [Hüft-TEP], bis zu 100 %ige Infektionseradikation). Ein alleiniges Vorgehen gemäß dem Konzept Débridement, Antibiotics, Implant Retention (DAIR) erzielt deutlich schlechtere Erfolgsraten (16–82 %). Die chirurgische Behandlung sollte stets durch eine postoperative Antibiotikatherapie mit einer Gesamtdauer von 12 Wochen ergänzt werden. Neben der etablierten perioperativen Antibiotikaprophylaxe zeigt sich die Verwendung von antibiotikahaltigem Knochenzement gegenüber der zementfreien Schaftverankerung in der Prävention der PPI bei Duokopfprothesen überlegen.

Abstract

Acute periprosthetic joint infections (PJI) after dual head arthroplasty represent a major challenge with a 1-year mortality rate up to 50% in the mostly multimorbid geriatric patient collective. Due to the limited possibilities of preoperative patient optimization, infection rates of up to 9% have been reported, which is significantly higher than in elective arthroplasty. A therapeutic gold standard has not yet been established due to the heterogeneous study situation and the lack of prospective randomized studies. The most promising therapeutic option currently appears to be a single-stage stem replacement in combination with implantation of a cup component (conversion to total hip arthroplasty, infection eradication in up to 100%). An approach of débridement, antibiotics, implant retention (DAIR) alone shows significantly poorer success rates (16–82%). Surgical treatment should always be followed by antibiotic treatment with a total duration of 12 weeks. In addition to the established perioperative antibiotic prophylaxis, the use of antibiotic-loaded bone cement seems to be superior to cementless stem fixation in preventing PJI in dual head arthroplasty.

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Authors and Affiliations

  1. Centrum für Muskuloskeletale Chirurgie, Charité – Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland

    Susanne Baertl,  Nora Renz,  Carsten Perka &  Stephanie Kirschbaum

  2. Klinik und Poliklinik für Unfallchirurgie, Universitätsklinikum Regensburg, Regensburg, Deutschland

    Susanne Baertl &  Volker Alt

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Correspondence to Stephanie Kirschbaum.

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S. Baertl, N. Renz, V. Alt, C. Perka und S. Kirschbaum geben an, dass kein Interessenkonflikt besteht.

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Volker Alt, Regensburg

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Baertl, S., Renz, N., Alt, V. et al. Akute postoperative Infektion nach Duokopfprothesenimplantation beim geriatrischen Patienten. Unfallchirurgie 127, 110–116 (2024). https://doi.org/10.1007/s00113-023-01376-z

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  • DOI: https://doi.org/10.1007/s00113-023-01376-z

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