Zusammenfassung
Mittels Gelenkprothese kann bei Patienten mit arthrotisch oder arthritisch destruierten Gelenken (Hüfte, Knie, Schulter und Ellenbogen) Schmerzfreiheit erreicht und gleichzeitig die Mobilität gesteigert werden. Die Gelenkprotheseninfektion gilt als schwerwiegende, implantatassoziierte Komplikation, welche mit erhöhter Morbidität und Gesundheitskosten einhergeht. Pathogenetisch handelt es sich bei der Gelenkprotheseninfektion um eine Fremdkörperinfektion mit Ausbildung eines Biofilms, was die Diagnose und Therapie erschwert. Low-grade-Infektionen einer Gelenkprothese manifestieren sich häufig in Form einer frühen Prothesenlockerung mit oder ohne persistierende Schmerzen. Klinisch ist somit ein Low-grade-Infekt kaum von einem aseptischen Prothesenversagen zu unterscheiden. Die definitive Diagnose einer Gelenkprotheseninfektion kann meistens erst durch die Kombination verschiedener prä- und intraoperativer Untersuchungen gestellt werden. Durch rheumatologische Grundkrankheiten kann das periprothetische Gewebe entzündlich verändert sein, sodass nur der kulturelle Nachweis des Mikroorganismus eine definitive Diagnose erlaubt. Der Therapieerfolg ist einerseits von einer adäquaten chirurgischen Intervention und andererseits von einer antibiotischen Langzeittherapie abhängig. Letztere sollte eine biofilmaktive Substanz enthalten.
In diesem Artikel werden Pathogenese, Epidemiologie, Diagnostik und Therapie einer Gelenkprotheseninfektion diskutiert. Dabei wird der Schwerpunkt auf die diagnostische Abklärung gelegt, zumal diese bei rheumatologischer Grundkrankheit erschwert sein kann.
Abstract
Prosthetic replacement surgery for hip, knee, shoulder, and elbow joints has become commonplace due to the great success of these procedures in restoring function to persons disabled by arthritis. One of the most feared complications is prosthetic joint infection, which is associated with significant morbidity and health care costs. The pathogenesis of prosthetic joint infections is influenced by microorganisms growing in biofilms, making these infections difficult to diagnose and eradicate. Low-grade infections are often manifest as early loosening with or without pain. They are therefore difficult to distinguish from aseptic failure. For an accurate diagnosis of prosthetic joint infections, a combination of preoperative and intraoperative tests is usually needed. Underlying rheumatologic disease can lead to periprosthetic inflammatory changes in tissue. Therefore, only the culture of the microorganism is definitive proof of infection. Successful treatment requires long-term antimicrobial therapy, ideally with an agent acting on adhering stationary-phase microorganisms, combined with an adequate surgical procedure.
In this article, the epidemiology, pathogenesis, diagnosis and treatment of prosthetic joint infections are reviewed. We focus on difficult diagnostic aspects in the context of underlying rheumatologic disease.
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Laffer, R.R., Ruef, C. Diagnose und Therapie von Gelenkprotheseninfektionen. Z. Rheumatol. 65, 12–17 (2006). https://doi.org/10.1007/s00393-005-0016-1
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DOI: https://doi.org/10.1007/s00393-005-0016-1