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Antibiotikazumischung zum Knochenzement beim septischen Prothesenwechsel

Addition of antibiotics to bone cement for septic prosthesis exchange

  • Operative Techniken
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Operative Orthopädie und Traumatologie Aims and scope Submit manuscript

Zusammenfassung

Operationsziel

Sanierung einer periprothetischen Infektion durch lokale Antibiotikatherapie in maximaler Dosierung. Als Trägermaterial wird handelsüblicher Knochenzement verwendet. Antibiotikahaltiger Knochenzement ist in der Orthopädie ein etabliertes Mittel zur Fixierung zementierter Implantate beim künstlichen Gelenkersatz. Er gehört in der Primär- und Revisionsendoprothetik neben der systemischen Gabe von Antibiotika zur routinemäßigen lokalen Antibiotikaprophylaxe.

Indikation

Bei der Behandlung periprothetischer Infektionen (PPI) nutzt man antibiotikahaltigen Knochenzement bei zweizeitigen septischen Wechseloperationen im prothesenfreien Intervall als Spacer und zur Reimplantation bei der zweiten Operation. Bei einzeitigen septischen Wechseloperationen ist er ein essentielles Mittel, um lokal ausreichende Antibiotikakonzentrationen zu erreichen, die nach radikalem Débridement des infizierten Gewebes eine direkte Reimplantation erlauben. Die hohe Antibiotikakonzentration verhindert die Rekolonisierung und Biofilmbildung auf der Oberfläche des neuen Implantats.

Kontraindikation

PPI mit Keimen, die auf die beimischbaren Antibiotika nachweislich resistent sind. Anästhesiologische Inoperabilität des Patienten. Nachgewiesene Allergie des Patienten auf Substanzen, die dem Zement beigemischt werden oder darin enthalten sind.

Operationstechnik

Homogenisieren des Antibiotikapulvers. Zumischung der Antibiotika zur Pulverphase des Knochenzements. Homogenisieren des Antibiotika-Zement-Gemischs im Rührsystem. Vermengen mit dem flüssigen Monomer und üblicher Rührvorgang. Zementapplikation auf gewohnte Art.

Abstract

Objective

Decontamination of periprosthetic infections by local antibiotic therapy with maximum dosing. Commercially available bone cement is used as the carrier material. Bone cement containing antibiotics is an established procedure in orthopedics for the fixation of cemented implants in artificial joint replacement. It is part of the primary and revision endoprosthetic treatment together with systemic administration of antibiotics for routine local antibiotic prophylaxis.

Indications

Bone cement containing antibiotics is used in the treatment of periprosthetic infections for two-stage septic exchange operations as a spacer in the prosthesis-free interval and for reimplantation in the second operation. In one-stage septic exchange operations it is an essential means of achieving a locally sufficient antibiotic concentration, which allows direct reimplantation following radical débridement of the infected tissue. The high antibiotic concentration prevents recolonization and formation of a biofilm on the surface of the new implant.

Contraindications

Periprosthetic infections with pathogens which are known to be resistant to the antibiotics used in the mixture. Unsuitability of patients for surgery under anesthesia. Known allergies of patients to substances mixed with or contained in the cement.

Operation technique

Homogenization of the powdered antibiotic. Mixing of the antibiotic with the powder phase of the bone cement. Homogenization of the antibiotic-cement mixture by stirring. Addition of the liquid monomer and the usual mixing procedure. Application of the cement in the routine manner.

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  1. HELIOS ENDO Klinik Hamburg, Holstenstr. 2, 22767, Hamburg, Deutschland

    A. Zahar & P. Hannah

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  1. A. Zahar
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  2. P. Hannah
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A. Zahar und P. Hannah geben an, dass kein Interessenkonflikt besteht.

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Zahar, A., Hannah, P. Antibiotikazumischung zum Knochenzement beim septischen Prothesenwechsel. Oper Orthop Traumatol 28, 138–144 (2016). https://doi.org/10.1007/s00064-015-0424-6

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  • DOI: https://doi.org/10.1007/s00064-015-0424-6

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