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Management periprothetischer Infektionen des Kniegelenks

Management of periprosthetic infections of the knee

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Zusammenfassung

Der endoprothetische Ersatz gehört zu den erfolgreichsten Operationen der modernen Medizin. Mit zunehmendem Einsatz von Knieprothesen steigt auch die Anzahl von periprothetischen Infektionen. Bei schmerzhafter Gelenkprothese oder Zeichen einer Frühlockerung muss mittels Gelenkpunktion eine Infektion ausgeschlossen werden. Ein Erhalt der Prothese mit Wechsel der beweglichen Teile ist nur bei akuten Infektionen möglich (< 4 Wochen nach Operation bzw. bei Symptomdauer < 3 Wochen bei hämatogenen Infektionen), sofern die Prothese stabil, die Weichteile intakt und kein Problemerreger nachgewiesen ist. In anderen Fällen muss ein kompletter ein- oder zweizeitiger Prothesenwechsel durchgeführt werden. Beim zweizeitigen Wechsel ist ein kurzes Intervall von 2–3 Wochen möglich, sofern eine Biofilm-aktive Therapie verfügbar ist. Rifampicin soll gezielt (nach Erregernachweis) und nur in Kombination mit einem weiteren wirksamen Antibiotikum eingesetzt werden. In diesem Beitrag werden die aktuellen Management-Konzepte der periprothetischen Infektion des Kniegelenkes diskutiert.

Abstract

Endoprosthetic replacement is one of the most successful operations in current medicine. As the implantation of knee prostheses increases, the number of periprosthetic infections is also rising. In case of painful or early loosening of the prosthesis an infection should be excluded by joint aspiration. Retention of the prosthesis with change of mobile parts is possible only in acute infections (< 4 weeks after surgery or duration of symptoms of <3 weeks in the case of hematogenous infection), if the prosthesis is stable, the soft tissue is intact, and no difficult-to-treat pathogens were found. In other cases a one- or two-stage prosthesis exchange should be performed. In a two-stage exchange, a short interval of 2–3 weeks is possible, if biofilm-active treatment is available. Rifampin should be used targeted (after isolation of the pathogen) and only in combination with another efficient antibiotic. In this article the current management concepts of periprosthetic infection of the knee are discussed.

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Authors and Affiliations

  1. Zentrum für septische Chirurgie, Centrum für Muskuloskeletale Chirurgie, Charité – Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland

    N. Renz, C. Perka &  A. Trampuz

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  1. N. Renz
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  2. C. Perka
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  3. A. Trampuz
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Correspondence to A. Trampuz.

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Interessenkonflikt

N. Renz, C. Perka, A. Trampuz geben an, dass kein Interessenkonflikt besteht. Empfehlungen zur Prävention, Diagnostik und Therapie von periprothetischen Infektionen, sowie Weiterbildungsveranstalltungen und Forschungsprojekte, sind auf der Internetseite der PRO-IMPLANT Stiftung (www.pro-implant-foundation.org) laufend aktualisiert.

Der vorliegende Beitrag enthält keine Studien an Mensch oder Tier.

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Renz, N., Perka, C. & Trampuz, A. Management periprothetischer Infektionen des Kniegelenks. Orthopäde 45, 65–71 (2016). https://doi.org/10.1007/s00132-015-3217-6

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  • DOI: https://doi.org/10.1007/s00132-015-3217-6

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