Management des Protheseninfekts

Abstract

The periprosthetic infection is a constant risk and a severe complication in joint arthroplasty. Systematic diagnostics under optimal conditions are necessary to establish a successful therapy. The patient's history, clinical examination and an elevated CRP-level provide the basis for the suspicion of an infection. The diagnosis is confirmed by identification of the pathogen from a sample collected through joint aspiration under sterile conditions. The microbiological examination is carried out in a laboratory that is specialised in the diagnosis of foreign body infections. The pattern of resistance of the identified pathogen determines the topical and systemic course of antibiotics to be used. The surgical treatment is characterised by exchange of the prosthesis and a radical debridement. The exchange can be done in one or two stages. The one-stage exchange offers several advantages in comparison to two or more stage procedures for all those involved - patient, surgeon and the health-care system - while providing the same results in successful elimination of the infection, with an even better functional outcome.