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Infekt nach Arthroskopie

Infection after arthroscopy

  • Leitthema
  • Published:
Arthroskopie Aims and scope

Zusammenfassung

Einleitung

Die postarthroskopische Gelenkinfektion stellt ein sehr seltenes Ereignis dar. Da jedoch die verspätete Diagnosestellung dramatische Folgen haben kann, ist eine frühe genaue Anamneseerhebung, Laboruntersuchungen und insbesondere die diagnostische Punktion oder bei klinisch hochgradigem Infektverdacht die intraoperative Probenentnahme (ohne vorherige Antibiotikagabe) notwendig.

Methoden

In früheren Infektstadien hat sich die arthroskopische Therapie bewährt. Die kalkulierte und dann antibiogrammgerechte antibiotische Therapie ist wichtiger Bestandteil des Therapiekonzepts. Einen Sonderfall stellen die implantatassoziierten Gelenkinfekte dar, die oft eine aufwändigere operative Therapie mit längerer Antibiotikagabe und Entscheidungen hinsichtlich Implantaterhalt oder -entfernung notwendig machen. In diesem Zusammenhang sollte dringend die interdisziplinäre Zusammenarbeit mit Infektiologen angestrebt werden.

Schlussfolgerung

Bei bestehenden Infektzeichen muss die Indikation zur operativen Revision rasch und großzügig gestellt werden. Um einer postoperativen Gelenksteife vorzubeugen, sollte die frühzeitige Mobilisation des Gelenks erfolgen und die Immobilisationsdauer so kurz wie möglich gehalten werden.

Abstract

Introduction

Postarthroscopy infections are rare. Because delayed diagnosis can have dramatic consequences, an early enquiry of patient history, blood examinations, and diagnostic puncture or—in case of strong suspicion of infection—intraoperative sampling (without previous antibiotics) is necessary.

Methods

For early-stage infections, arthroscopic therapy has proven valuable. In addition, calculated and antibiogram-adjusted antibiotic therapy is essential. A special case is implant-associated joint infection, which requires a more complex surgical therapy with often longer antibiotic treatment and decisions concerning implant preservation or removal. In this context, interdepartmental cooperation is desired.

Conclusion

If signs of infection are present, the indication for surgical revision should be considered quickly and comprehensively. To prevent joint stiffness, mobilization should be started early and the duration of immobilization should be kept as short as possible.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. A.B. Imhoff, K. Schumann, S. Buchmann, J. Paul geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag enthält keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Klinikum rechts der Isar, Abteilung und Poliklinik für Sportorthopädie, Technische Universität München, Ismaningerstr. 22, 81675, München, Deutschland

    K. Schumann, S. Buchmann &  A.B. Imhoff

  2. Orthopädische Universitätsklinik, Universitätsspital Basel, Basel, Schweiz

    J. Paul

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  1. K. Schumann
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  2. S. Buchmann
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  4. A.B. Imhoff
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Correspondence to A.B. Imhoff.

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Schumann, K., Buchmann, S., Paul, J. et al. Infekt nach Arthroskopie. Arthroskopie 26, 259–266 (2013). https://doi.org/10.1007/s00142-013-0761-0

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