Diagnostik und therapeutisches Vorgehen beim Knieprotheseninfekt

  • Christoph H. Lohmann
  • Alexander P. Krüger
Chapter

Zusammenfassung

Die Anzahl der Knietotalendoprothesenträger nimmt jedes Jahr kontinuierlich zu. Ursache dafür sind die gestiegene Lebenserwartung der Bevölkerung, die höheren Ansprüche an die Lebensqualität der Patienten und die Ausweitung der Indikation, bedingt durch verbesserte Prothesendesigns, Qualität und Implantationsmöglichkeiten, sowie die verbesserte Implantationsqualität. Die positiven Effekte der Versorgung eines Patienten mit einer totalen Knieendoprothese sind hinlänglich bekannt und wurden in den vorangegangenen Kapiteln ausführlich beschrieben. Neben den direkten Nachteilen einer Operation wie Schmerz, Krankenhausaufenthalt, verlängerte Nachbehandlung etc. muss der Patient jedoch das Risiko einer bakteriellen Kniegelenkinfektion in Kauf nehmen. In den letzten Jahrzehnten ist das Risiko einer periprothetischen Infektion durch Verbesserung der perioperativen Infektprophylaxe deutlich gesunken. Das tatsächliche Risiko eines Patienten, nach totalem Kniegelenkersatz an einer bakteriellen Besiedelung zu erkranken, ist in der Literatur nicht einheitlich angegeben. Man muss von einer Infektionsrate nach primärer Knietotaloperation von bis zu 2 % in den ersten zwei Jahren ausgehen. In der Literatur wird die Infektionsrate elektiver Gelenkersatzoperation je nach Kollektiv und Erfassungszeitraum in Größenordnungen von 0,5–1,5 % angegeben. Bei Vorerkrankungen und Revisionserkrankungen steigen die Angaben auf bis zu 5 %, bei Reimplantationen nach periprothetischer Infektion bis in die Größenordnung von 15–20 % an.

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Literatur

  1. 1.
    Vastag B (2004) Knee replacement underused say panel: useful option when nonsurgical therapies fail. JAMA 291(4):413–414PubMedCrossRefGoogle Scholar
  2. 2.
    Garvin KL, Hanssen AD (1995) Infection after total hip arthroplasty. Past, present, and future. J Bone Joint Surg Am 77(10):1576–1588PubMedGoogle Scholar
  3. 3.
    Zimmerli W, Trampuz A, Ochsner PE (2004) Prosthetic-joint-infections. N Engl J Med 351 (16):1645–1654PubMedCrossRefGoogle Scholar
  4. 4.
    Berbari EF, Hanssen AD, Duffy MC et al (1998) Risk factors for prosthetic joint infection: case-control study. Clin Infect Dis 27:1247–1254PubMedCrossRefGoogle Scholar
  5. 5.
    Berbari EF, Marculescu C, Sia I et al (2007) Culture-negative prosthetic joint infection. Clin Infect Dis 45:1113– 1119PubMedCrossRefGoogle Scholar
  6. 6.
    Berbari EF, Osmon DR, Duffy MC et al (2006) Outcome of prosthetic joint infection in patients with rheumatoid arthritis: the impact of medical and surgical therapy in 200 episodes. Clin Infect Dis 42:216–223PubMedCrossRefGoogle Scholar
  7. 7.
    Crockarell JR, Hanssen AD, Osmon DR, Morrey BF (1998) Treatment of infection with debridement and retention of the components following hip arthroplasty. J Bone Joint Surg Am 80:1306–1313PubMedGoogle Scholar
  8. 8.
    Haaker R, Senge A, Kramer J, Rubenthaler F (2004) Osteomyelitis after endoprostheses. Orthopade 33:431– 438PubMedCrossRefGoogle Scholar
  9. 9.
    Hanssen AD, Rand JA (1999) Evaluation and treatment of infection at the site of a total hip or knee arthroplasty. Instr Course Lect 48:111–122PubMedGoogle Scholar
  10. 10.
    Lehner B, Witte D, Suda A, Weiss S (2009) Revision strategy for periprosthetic infection. Orthopade 38:681– 688PubMedCrossRefGoogle Scholar
  11. 11.
    Phillips JE, Crane TP, Noy M et al (2006) The incidence of deep prosthetic infections in a specialist orthopaedic hospital: A 15-year prospective survey. J Bone Joint Surg Br 88-B:943–948CrossRefGoogle Scholar
  12. 12.
    Trampuz A, Osmon DR, Hanssen AD et al. (2003) Molecular and antibiofilm approaches to prosthesic joint infection. Clin Orthop Relat Res 414:69–88PubMedCrossRefGoogle Scholar
  13. 13.
    Ahlberg A, Carlsson AS, Lindberg L (1978) Hematogenous infection in total joint replacement. Clin Orthop Relat Res 69–75Google Scholar
  14. 14.
    Geipel U, Herrmann M (2005) The infected implant: bacteriology. Unfallchirurg 108:961–975PubMedCrossRefGoogle Scholar
  15. 15.
    Hanssen AD, Rand JA (1999) Evaluation and treatment of infection at the site of a total hip or knee arthroplasty. Instr Course Lect 48:111–122PubMedGoogle Scholar
  16. 16.
    Powers KA, Terpenning MS, Voice RA, Kauffman CA (1990) Prosthetic joint infections in the elderly. Am J Med 88:9N–13NPubMedGoogle Scholar
  17. 17.
    Schafroth M, Zimmerli W, Brunazzi M, Ochsner PE (2003) Infektionen. In: Ochsner PE (Hrsg) Die Hüfttotalprothese. Springer, Berlin Heidelberg New York Tokio, S 65–90Google Scholar
  18. 18.
    Schafroth M, Zimmerli W, Ochsner PE (1999) Das infizierte künstliche Hüftgelenk: Möglichkeiten, Verlauf und Resultate der Behandlung. Praxis 88:2101–2105PubMedGoogle Scholar
  19. 19.
    Costerton JW, Geesey GG, Cheng KJ (1978) How bacteria stick. Sci Am 238:86–95PubMedCrossRefGoogle Scholar
  20. 20.
    Militz M, Bühren V (2010) Wechsel infizierter Knieendoprothesen. Chirurg 81: 310–320PubMedCrossRefGoogle Scholar
  21. 21.
    Zimmerli W, Lew PD, Waldvogel FA (1984) Pathogenesis of foreign body infection. Evidence for a local granulocyte defect. J Clin Invest 73(4):1191–1200PubMedCrossRefGoogle Scholar
  22. 22.
    Murdoch DR, Roberts SA, Fowler VG Jr et al. (2001) Infection of orthopedic prostheses after Staphylococcus aureus bacteremia. Clin Infect Dis 32(4):647–649PubMedCrossRefGoogle Scholar
  23. 23.
    Bauer TW, Parvizi J, Kobayashi N, Krebs V (2006) Diagnosis of periprosthetic infection. J Bone Joint Surg Am 88:869–882PubMedCrossRefGoogle Scholar
  24. 24.
    Friesecke C, Wodtke J (2008) Management of periprosthetic infection. Chirurg 79:777–792PubMedCrossRefGoogle Scholar
  25. 25.
    Frommelt L (2009) Diagnosis and treatment of foreign-body-associated infection in orthopaedic surgery. Orthopade 38(9):806–811CrossRefGoogle Scholar
  26. 26.
    Gollwitzer H, Diehl P, Gerdesmeyer L, Mittelmeier W (2006) Diagnostic strategies in cases of suspected periprosthetic infection of the knee. A review of the literature and current recommendations. Orthopade 35:904–906PubMedCrossRefGoogle Scholar
  27. 27.
    Toms AD, Davidson D, Masri BA, Duncan CP (2006) The management of peri-prosthetic infection in total joint arthroplasty. J Bone Joint Surg Br 88-B:149–155CrossRefGoogle Scholar
  28. 28.
    Mihalko WM, Manaswi A, Cui Q et al (2008) Diagnosis and treatment of the infected primary total knee arthroplasty. Instr Course Lect 57:327–339PubMedGoogle Scholar
  29. 29.
    Mason JB, Fehring TK, Odum SM et al (2003) The value of white blood cell counts before revision total knee arthroplasty. J Arthroplasty 18:1038–1043PubMedCrossRefGoogle Scholar
  30. 30.
    Ghanem E, Ketonis C, Restrepo C et al (2009) Periprosthetic infection: where do we stand with regard to Gram stain? Acta Orthop 80:37–40PubMedCrossRefGoogle Scholar
  31. 31.
    Al LN, Rohde H, Sander G et al (2007) Augmented expression of polysaccharide intercellular adhesin in a defined Staphylococcus epidermidis mutant with the small-colony-variant phenotype. J Bacteriol 189:4494– 4501CrossRefGoogle Scholar
  32. 32.
    Geipel U (2009) Pathogenic organisms in hip joint infections. Int J Med Sci 6:234–240PubMedGoogle Scholar
  33. 33.
    Ince A, Rupp J, Frommelt L et al (2004) Is»aseptic« loosening of the prosthetic cup after total hip replacement due to nonculturable bacterial pathogens in patients with low-grade infection? Clin Infect Dis 39:1599–1603PubMedCrossRefGoogle Scholar
  34. 34.
    Kordelle J, Frommelt L, Kluber D, Seemann K (2000) Results of one-stage endoprosthesis revision in periprosthetic infection caused by methicillin-resistant staphylococcus aureus. Z Orthop Ihre Grenzgeb 138:240–244PubMedCrossRefGoogle Scholar
  35. 35.
    Mariani BD, Tuan RS (1998) Advances in the diagnosis of infection in prosthetic joint implants. Mol Med Today 4:207–213PubMedCrossRefGoogle Scholar
  36. 36.
    Mooij MJ, Drenkard E, Llamas MA et al (2007) Characterization of the integrated filamentous phage Pf5 and its involvement in small-colony formation. Microbiology 153:1790–1798PubMedCrossRefGoogle Scholar
  37. 37.
    Cramer J, Ekkernkamp A, Ostermann PA (2001) The infected endoprosthesis with the example of the hip joint endoprosthesis. An increasing danger to patient and society. Z Arztl Fortbild Qualitatssich 95:195–201PubMedGoogle Scholar
  38. 38.
    Krenn V, Otto M, Morawietz L et al (2009) Histopathologic diagnostics in endoprosthetics: periprosthetic neosynovialitis, hypersensitivity reaction and arthrofibrosis. Orthopade 38:520–530PubMedCrossRefGoogle Scholar
  39. 39.
    Morawietz L, Classen RA, Schroder JH et al (2006) Proposal for a histopathological consensus classification of the periprosthetic interface membrane. J Clin Pathol 59:591–597PubMedCrossRefGoogle Scholar
  40. 40.
    Neut D, van H Jr, Kooten TG van et al (2003) Detection of biomaterial-associated infections in orthopaedic joint implants. Clin Orthop Relat Res 261–268Google Scholar
  41. 41.
    Schafer P, Fink B, Sandow D et al (2008) Prolonged bacterial culture to identify late periprosthetic joint infection: a promising strategy. Clin Infect Dis 47:1403–1409PubMedCrossRefGoogle Scholar
  42. 42.
    Fitzgerald RH Jr, Nolan DR, Ilstrup DM et al (1977) Deep wound sepsis following total hip arthroplasty. J Bone Joint Surg Am 59:847–855PubMedGoogle Scholar
  43. 43.
    Hirakawa K, Stulberg BN, Wilde AH et al. (1998) Results of 2-stage reimplantation for infected total knee arthroplasty. J Arthroplasty 13(1):22–28PubMedCrossRefGoogle Scholar
  44. 44.
    Goldman RT, Scuderi GR, Insall JN (1996) 2-stage reimplantation for infected total knee replacement. Clin Orthop Relat Res 331:118–124PubMedCrossRefGoogle Scholar
  45. 45.
    Friesecke C, Wodtke J (2006) Periprosthetic knee infection. One-stage exchange. Orthopade 35:937–1005PubMedCrossRefGoogle Scholar
  46. 46.
    Munjal S, Phillips MJ, Krackow KA (2001) Revision total knee arthroplasty: planning, controversies and management – infection. Instr Course Lect 50:367–377PubMedGoogle Scholar
  47. 47.
    Ruchholtz S, Täger G, Nast-Kolb D (2004) Die infizierte Hüftgelenksendoprothese. Unfallchirurg 4:307–319CrossRefGoogle Scholar
  48. 48.
    Fink B, Makowiak C, Fuerst M et al (2008) The value of synovial biopsy, joint aspiration and C-reactive protein in the diagnosis of late peri-prosthetic infection of total knee replacements. J Bone Joint Surg Br 90-B:874–878CrossRefGoogle Scholar
  49. 49.
    Maurer TB, Ochsner PE (2006) Infected knee arthroplasty. A treatment algorithm at the Kantonsspital Liestal, Switzerland. Orthopade 35:917–918PubMedCrossRefGoogle Scholar
  50. 50.
    Frommelt L (2009) Diagnosis and treatment of foreign-body-associated infection in orthopaedic surgery. Orthopade 38(9):806–811CrossRefGoogle Scholar
  51. 51.
    Hope PG, Kristinsson KG, Norman P, Elson RA (1989) Deep infection of cemented total hip arthroplasties caused by coagulase-negative staphylococci. J Bone Joint Surg Br 71-B:851–855Google Scholar
  52. 52.
    Anagnostakos K, Kelm J, Schmitt E (2006) Indications for use of the V.A.C.-system in the orthopedic surgery. Zentralbl Chir 131 [Suppl 1]:87–92CrossRefGoogle Scholar
  53. 53.
    Kelm J, Anagnostakos K, Schmitt E (2004) Closed subfascial V.A.C.-therapy in periprosthetic hip infections. Zentralbl Chir 129 [Suppl 1]:49–52Google Scholar
  54. 54.
    Kelm J, Schmitt E, Anagnostakos K (2009) Vacuum-assisted closure in the treatment of early hip joint infections. Int J Med Sci 6:241–246PubMedGoogle Scholar
  55. 55.
    Mitchell PA, Masri BA, Garbuz DS et al (2003) Cementless revision for infection following total hip arthroplasty. Instr Course Lect 52:323–330PubMedGoogle Scholar
  56. 56.
    Raut VV, Siney PD, Wroblewski BM (1995) One-stage revision of total hip arthroplasty for deep infection. Longterm follow up. Clin Orthop Relat Res 202–207Google Scholar
  57. 57.
    Steinbrink K, Frommelt L (1995) Treatment of periprosthetic infection of the hip using one-stage exchange surgery. Orthopade 24:335–343PubMedGoogle Scholar
  58. 58.
    Disch AC, Matziolis G, Perka C (2007) Two-stage operative strategy without local antibiotic treatment for infected hip arthroplasty: clinical and radiological outcome. Arch Orthop Trauma Surg 127:691–697PubMedCrossRefGoogle Scholar
  59. 59.
    Frommelt L (2004) Guidelines on antimicrobial therapy in situations of periprosthetic THR infection. Orthopade 33:822–828PubMedCrossRefGoogle Scholar
  60. 60.
    Leone JM, Hanssen AD (2006) Management of infection at the site of a total knee arthroplasty. Instr Course Lect 55:449–461PubMedGoogle Scholar
  61. 61.
    Moyad TF, Thornhill T, Estok D (2008) Evaluation and management of the infected total hip and knee. Orthopedics 31:581–588PubMedCrossRefGoogle Scholar
  62. 62.
    Simmons TD, Stern SH (1996) Diagnosis and management of the infected total knee arthroplasty. Am J Knee Surg 9:99–106PubMedGoogle Scholar
  63. 63.
    Toms AD, Davidson D, Masri BA, Duncan CP (2006) The management of peri-prosthetic infection in total joint arthroplasty. J Bone Joint Surg Br 88-B:149–155CrossRefGoogle Scholar
  64. 64.
    Biring GS, Kostamo T, Garbuz DS et al (2009) Two-stage revision arthroplasty of the hip for infection using an interim articulated Prostalac hip spacer: a 10- to 15-year follow-up study. J Bone Joint Surg Br 91:1431–1437PubMedCrossRefGoogle Scholar
  65. 65.
    Cuckler JM, Star AM, Alavi A, Noto RB (1991) Diagnosis and management of the infected total joint arthroplasty. Orthop Clin North Am 22:523–530PubMedGoogle Scholar
  66. 66.
    Haddad FS, Muirhead-Allwood SK, Manktelow AR, Bacarese-Hamilton I (2000) Two-stage uncemented revision hip arthroplasty for infection. J Bone Joint Surg Br 82:689–694PubMedCrossRefGoogle Scholar
  67. 67.
    Jamsen E, Stogiannidis I, Malmivaara A et al (2009) Outcome of prosthesis exchange for infected knee arthroplasty: the effect of treatment approach. Acta Orthop 80:67–77PubMedCrossRefGoogle Scholar
  68. 68.
    Mittal Y, Fehring TK, Hanssen A et al (2007) Two-stage reimplantation for periprosthetic knee infection involving resistant organisms. J Bone Joint Surg Am 89:1227–1231PubMedCrossRefGoogle Scholar
  69. 69.
    Thabe H, Schill S (2007) Two-stage reimplantation with an application spacer and combined with delivery of antibiotics in the management of prosthetic joint infection. Oper Orthop Traumatol 19:78–100PubMedCrossRefGoogle Scholar
  70. 70.
    Durbhakula SM, Czajka J, Fuchs MD, Uhl RL (2004) Antibiotic-loaded articulating cement spacer in the 2-stage exchange of infected total knee arthroplasty. J Arthroplasty 19:768–774PubMedCrossRefGoogle Scholar
  71. 71.
    Durbhakula SM, Czajka J, Fuchs MD, Uhl RL (2004) Spacer endoprosthesis for the treatment of infected total hip arthroplasty. J Arthroplasty 19:760–767PubMedCrossRefGoogle Scholar
  72. 72.
    Husted H, Jensen T (2002) Clinical outcome after treatment of infected primary total knee arthroplasty. Acta Orthop Belg 68:500–507PubMedGoogle Scholar
  73. 73.
    Pietsch M, Hofmann S, Wenisch C (2006) Treatment of deep infection of total knee arthroplasty using a twostage procedure. Oper Orthop Traumatol 18:66–87PubMedCrossRefGoogle Scholar
  74. 74.
    Pietsch M, Wenisch C, Traussnig S et al (2003) Temporary articulating spacer with antibiotic-impregnated cement for an infected knee endoprosthesis. Orthopade 32:490–497PubMedGoogle Scholar
  75. 75.
    Souillac V, Costes S, Aunoble S et al (2006) Evaluation of an articulated spacer for two-stage reimplantation for infected total knee arthroplasty: 28 cases. Rev Chir Orthop Reparatrice Appar Mot 92:485–489PubMedGoogle Scholar
  76. 76.
    Whittaker JP, Warren RE, Jones RS, Gregson PA (2009) Is prolonged systemic antibiotic treatment essential in two-stage revision hip replacement for chronic Gram-positive infection? J Bone Joint Surg Br 91:44–51PubMedGoogle Scholar
  77. 77.
    Anagnostakos K, Wilmes P, Schmitt E, Kelm J (2009) Elution of gentamicin and vancomycin from polymethylmethacrylate beads and hip spacers in vivo. Acta Orthop 80:193–197PubMedCrossRefGoogle Scholar
  78. 78.
    Andollina A, Bertoni G, Zolezzi C et al (2008) Vancomycin and meropenem in acrylic cement: elution kinetics of in vitro bactericidal action. Chir Organi Mov 91:153–158PubMedCrossRefGoogle Scholar
  79. 79.
    Evans RP (2004) Successful treatment of total hip and knee infection with articulating antibiotic components: a modified treatment method. Clin Orthop Relat Res 37–46Google Scholar
  80. 80.
    Masri BA, Duncan CP, Beauchamp CP (1998) Long-term elution of antibiotics from bone-cement: an in vivo study using the prosthesis of antibiotic-loaded acrylic cement (PROSTALAC) system. J Arthroplasty 13:331– 338PubMedCrossRefGoogle Scholar
  81. 81.
    Seldes RM, Winiarsky R, Jordan LC et al (2005) Liquid gentamicin in bone cement: a laboratory study of a potentially more cost-effective cement spacer. J Bone Joint Surg Am 87:268–272PubMedCrossRefGoogle Scholar
  82. 82.
    Shiramizu K, Lovric V, Leung A, Walsh WR (2008) How do porosity-inducing techniques affect antibiotic elution from bone cement? An in vitro comparison between hydrogen peroxide and a mechanical mixer. J Orthop Traumatol 9:17–22PubMedCrossRefGoogle Scholar
  83. 83.
    Stevens CM, Tetsworth KD, Calhoun JH, Mader JT (2005) An articulated antibiotic spacer used for infected total knee arthroplasty: a comparative in vitro elution study of simplex and palacos bone cements. J Orthop Res 23:27–33PubMedCrossRefGoogle Scholar
  84. 84.
    Antoci V, Phillips MJ, Antoci V Jr, Krackow KA (2009) Using an antibiotic-impregnated cement rod-spacer in the treatment of infected total knee arthroplasty. Am J Orthop 38:31–33PubMedCrossRefGoogle Scholar
  85. 85.
    Dairaku K, Takagi M, Kawaji H et al (2009) Antibiotics-impregnated cement spacers in the first step of twostage revision for infected totally replaced hip joints: report of ten trial cases. J Orthop Sci 14:704–710PubMedCrossRefGoogle Scholar
  86. 86.
    Hart WJ, Jones RS (2006) Two-stage revision of infected total knee replacements using articulating cement spacers and short-term antibiotic therapy. J Bone Joint Surg Br 88:1011–1015PubMedCrossRefGoogle Scholar
  87. 87.
    Hsieh PH, Chang YH, Chen SH et al (2006) High concentration and bioactivity of vancomycin and aztreonam eluted from Simplex cement spacers in two-stage revision of infected hip implants: a study of 46 patients at an average follow-up of 107 days. J Orthop Res 24:1615–1621PubMedCrossRefGoogle Scholar
  88. 88.
    Hsieh PH, Huang KC, Lee PC, Lee MS (2009) Two-stage revision of infected hip arthroplasty using an antibioticloaded spacer: retrospective comparison between short-term and prolonged antibiotic therapy. J Antimicrob Chemother 64:392–397PubMedCrossRefGoogle Scholar
  89. 89.
    Hsieh PH, Shih CH, Chang YH et al (2005) Treatment of deep infection of the hip associated with massive bone loss: two-stage revision with an antibiotic-loaded interim cement prosthesis followed by reconstruction with allograft. J Bone Joint Surg Br 87:770–775PubMedCrossRefGoogle Scholar
  90. 90.
    Hsu CS, Hsu CC, Wang JW, Lin PC (2008) Two-stage revision of infected total knee arthroplasty using an antibiotic-impregnated static cement-spacer. Chang Gung Med J 31:583–591PubMedGoogle Scholar
  91. 91.
    Jamsen E, Sheng P, Halonen P et al (2006) Spacer prostheses in two-stage revision of infected knee arthroplasty. Int Orthop 30:257–261PubMedCrossRefGoogle Scholar
  92. 92.
    Jiranek WA, Hanssen AD, Greenwald AS (2006) Antibiotic-loaded bone cement for infection prophylaxis in total joint replacement. J Bone Joint Surg Am 88:2487–2500PubMedCrossRefGoogle Scholar
  93. 93.
    Proctor RA, von EC, Kahl BC et al (2006) Small colony variants: a pathogenic form of bacteria that facilitates persistent and recurrent infections. Nat Rev Microbiol 4:295–305PubMedCrossRefGoogle Scholar
  94. 94.
    Sudo A, Hasegawa M, Fukuda A, Uchida A (2008) Treatment of infected hip arthroplasty with antibioticimpregnated calcium hydroxyapatite. J Arthroplasty 23:145–150PubMedCrossRefGoogle Scholar
  95. 95.
    Takigami I, Ito Y, Ishimaru D et al (2009) Two-stage revision surgery for hip prosthesis infection using antibiotic- loaded porous hydroxyapatite blocks. Arch Orthop Trauma SurgGoogle Scholar
  96. 96.
    Villanueva-Martinez M, Rios-Luna A, Pereiro J et al (2008) Hand-made articulating spacers in two-stage revision for infected total knee arthroplasty: good outcome in 30 patients. Acta Orthop 79:674–682PubMedCrossRefGoogle Scholar
  97. 97.
    Ghanem E, Ketonis C, Restrepo C et al (2009) Periprosthetic infection: where do we stand with regard to Gram stain? Acta Orthop 80:37–40PubMedCrossRefGoogle Scholar
  98. 98.
    Willert HG, Buchhorn GH, Fayyazi A, Flury R, Windler M, Köster G, Lohmann CH (2005) Metal-on-Metal Bearings and Hypersensitivity in Patients with Artificial Hip Joints. A Clinical and Histomorphological Study. J Bone Joint Surg (A) 87:28–36CrossRefGoogle Scholar
  99. 99.
    C.H. Lohmann, M.Fuerst, O.Niggemeyer, W.Rüther (2007) Die Behandlung von periprothetischen Infektionen. Zeitschrift fürRheumatologie, Springer 10.2010/s00393-006-0141-5Google Scholar

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© Springer-Verlag Berlin Heidelberg 2011

Authors and Affiliations

  • Christoph H. Lohmann
    • 1
  • Alexander P. Krüger
    • 1
  1. 1.Orthopädische UniversitätsklinikOtto-von-Guericke Universität MagdeburgMadgeburgGermany

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