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Komplikationsmanagement bei infizierter Osteosynthese

Therapiealgorithmus bei periimplantären Infektionen

Complication management of infected osteosynthesis

Therapy algorithm for peri-implant infections

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Zusammenfassung

Hintergrund

Periimplantäre Infektionen (PII) zählen zu den häufigsten postoperativen Komplikationen und erfordern in der Regel ein kombiniertes chirurgisches und antibiotisches Vorgehen. In diesem Übersichtsartikel stellen wir die aktuellen Kenntnisse bezüglich der Pathogenese, Klassifikation, Diagnose und Therapie osteosyntheseassoziierter Infektionen vor. Ziel der Arbeit ist es, die rationalen Hintergründe und die Evidenz der einzelnen chirurgischen Maßnahmen zu erläutern und konkrete Therapieempfehlungen auszuarbeiten.

Material und Methoden

Anhand der aktuellen relevanten Fachliteratur wurden Informationen zur Diagnostik, Therapie und Prävention kritisch interpretiert. Aufgrund dieser Daten wurde ein abgestimmtes kombiniertes chirurgisches und antibiotisches Behandlungskonzept vorgestellt.

Ergebnisse

Mit einem konsequenten, interdisziplinären Vorgehen können hohe Heilungsraten mit Elimination der PII erzielt werden. Bei akuten PII kann das Osteosynthesematerial meist erhalten werden (vorausgesetzt die Weichteile lassen dies zu), während bei einer chronischen PII das Implantat in der Regel ein- oder zweizeitig gewechselt werden muss (abhängig von Weichteilen, Knochen, Erreger).

Diskussion

Wissenschaftliche Erkenntnisse und klinische Daten führen zu neuen Behandlungskonzepten mit verbessertem Outcome, Verminderung der Morbidität und verkürztem Krankenhausaufenthalt. Systemische Antibiotika sind ein wichtiger Bestandteil der wirksamen Behandlung akuter und chronischer PII. Die lokale Anwendung von Antibiotika und der Einsatz von Knochenersatzmaterialien stellen weitere Behandlungsoptionen dar, deren genauer Stellenwert muss jedoch noch ermittelt werden.

Abstract

Background

Peri-implant infections (PII) are one of the most frequent postoperative complications and require an individualized combined surgical and antibiotic management. In this review article we provide up to date scientific knowledge regarding the pathogenesis, classification, diagnosis and therapy of PII. The aim of this article is to explain the rational background and evidence of individual treatment options in order to elaborate concrete management recommendations.

Material and methods

The relevant scientific publications were critically reviewed for diagnostics, therapy and prevention of PII. Based on these data we present a combined surgical and antibiotic treatment algorithm for PII.

Results

With a consistent interdisciplinary action high healing rates with eradication of PII can be achieved. In acute PII (< 6 weeks) the implant can normally be retained but this is dependent on the soft tissue conditions, while in chronic PII (> 6 weeks) the implant generally has to be removed in a one or two step exchange, depending on the soft tissue, bone defects and pathogen.

Conclusion

Scientific knowledge and clinical data have led to new treatment algorithms for PII with improved outcome, decreased morbidity and shortened hospitalization. Systemic individualized antimicrobial therapy, radical septic and plastic surgery are the cornerstones for successful treatment of acute and chronic PII. The local use of antibiotics and application of bone substitute materials are other techniques for treatment but the exact importance must still be determined.

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Authors and Affiliations

  1. Centrum für septische Chirurgie am Centrum für Muskuloskeletale Chirurgie, Charité – Universitätsmedizin, Augustenburger Platz 1, 13353, Berlin, Deutschland

    C. Kleber &  A. Trampuz

  2. UniversitätsCentrum für Orthopädie und Unfallchirurgie, Universitätsklinikum Carl Gustav Carus, Dresden, Deutschland

    C. Kleber &  K.D. Schaser

Authors
  1. C. Kleber
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  2. K.D. Schaser
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  3. A. Trampuz
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Correspondence to C. Kleber.

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Interessenskonflikt

C. Kleber, K.D. Schaser und A. Trampuz geben an, dass kein Interessenskonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Kleber, C., Schaser, K. & Trampuz, A. Komplikationsmanagement bei infizierter Osteosynthese. Chirurg 86, 925–934 (2015). https://doi.org/10.1007/s00104-015-0073-1

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