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Die Behandlung von periprothetischen Infektionen

The treatment of periprosthetic infections

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Zusammenfassung

Die Infektionsrate des primären künstlichen Gelenkersatzes beträgt 0,5–2%. Als Risikofaktoren gelten systemische Erkrankungen wie rheumatoide Arthritis (RA) oder vorangegangene Operationen. Die Infektionsrate an dem hier präsentierten Patientengut ist gering (0,72%). Die Re-Infektionsrate (23,4%) in der vorgelegten Studie ist durch Patienten mit RA und septischen Knieendoprothesen bedingt.

Die erfolgreiche Therapie hängt von verschiedenen Faktoren ab – essenziell ist eine akkurate präoperative bakterielle Diagnostik. Die Gelenkpunktion ist das Verfahren der Wahl. Sie kann bei bestehender Unsicherheit der Diagnose durch die offene Biopsie bzw. arthroskopisch gestützte Biopsie ergänzt werden. Eine Frühinfektion kann durch ein agressives Débridement ohne Wechsel der festen Implantatkomponenten behandelt werden, die „Low-grade-Infektion“ oder die Spätinfektion werden grundsätzlich mit dem Austausch des Implantats als ein- oder zweizeitiger Wechsel gemäß klar definierten Algorithmen therapiert. Die Antibiotikakombinationstherapie mit Rifampicin ist eine Grundlage in der Behandlung.

Abstract

Periprosthetic infections are severe complications following total joint arthroplasty. The infection rate is estimated to be 0.5–2%. Systemic diseases such as rheumatoid arthritis and previous surgery are considered risk factors for infection. The infection rate in the present patient cohort was low (0.72%). The recurrence rate (23.4%) is due to patients with rheumatoid arthritis and septic total knee arthroplasties.

Successful treatment is dependent on various factors, one of which involves accurate preoperative bacterial diagnostics. Joint fluid aspiration is the appropriate procedure. Open biopsy or arthroscopically guided biopsy can be performed in cases of unclear diagnostic results. Early infection can be treated with thorough joint debridement without exchanging fixed implant components; “low-grade” or late infections require revision with implant removal in a one or two stage septic revision according to clearly determined algorithms. Antibiotic therapy is mandatory, and a combination with rifampicin is a very useful basis.

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Authors and Affiliations

  1. Lehrstuhl für Orthopädie, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland

    C.H. Lohmann & W. Rüther

  2. Rheumaklinik Bad Bramstedt, Oskar-Alexander-Straße 26, 25476, Bad Bramstedt, Deutschland

    C.H. Lohmann, M. Fürst, O. Niggemeyer & W. Rüther

Authors
  1. C.H. Lohmann
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  2. M. Fürst
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  3. O. Niggemeyer
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  4. W. Rüther
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Correspondence to C.H. Lohmann.

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Lohmann, C., Fürst, M., Niggemeyer, O. et al. Die Behandlung von periprothetischen Infektionen. Z Rheumatol 66, 28–33 (2007). https://doi.org/10.1007/s00393-006-0141-5

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