[Septic revision arthroplasty: how to confirm diagnosis, plan surgery and manage follow-up treatment].
Septische Revisionsprothetik: Vorbereitung, Durchführung und Nachbehandlung.
Algorithms
Antibiotics
Arthroplasty
Biofilm
Revision arthroplasty
Journal
Der Orthopade
ISSN: 1433-0431
Titre abrégé: Orthopade
Pays: Germany
ID NLM: 0331266
Informations de publication
Date de publication:
Dec 2021
Dec 2021
Historique:
accepted:
15
09
2021
pubmed:
16
10
2021
medline:
15
12
2021
entrez:
15
10
2021
Statut:
ppublish
Résumé
Septic revision arthroplasty represents an interdisciplinary challenge in terms of diagnosis as well as surgical and follow-up treatment. The implementation of a standardized diagnostic algorithm including anamnesis, clinic, imaging, blood sampling and joint aspiration is essential. Depending on the duration of the symptoms acute (< 3 weeks) and chronic (> 3 weeks) infections are distinguished. While acute infections show an immature biofilm and can usually be addressed surgically via debridement and changing the mobile parts, chronic infections almost always require a complete change of the implant. This can be done in one or two stages, depending on the general condition of the patient, the pathogen, its resistances as well as the wound conditions. The surgical revision is always followed by a resistance-based antibiotic treatment. HINTERGRUND: Die septische Revisionsendoprothetik stellt in ihrer Diagnostik, Durchführung und Nachbehandlung eine interdisziplinäre Herausforderung dar. Zur Sicherung der Diagnose muss das Abarbeiten eines standardisierten Algorithmus erfolgen: Anamnese, Klinik, Bildgebung, Blutentnahme und Gelenkpunktion sind die diagnostischen Grundpfeiler. Letztere sollte immer die Bestimmung der Leukozytenzahl, die Bestimmung der neutrophilen Granulozyten und eine mikrobiologische Untersuchung des Punktats umfassen. Abhängig von der Dauer der angegebenen Beschwerden unterscheidet man klinisch zwischen akuten (< 3 Wochen) und chronischen (> 3 Wochen) Infekten. Während akute Infektionen einen unreifen Biofilm aufweisen und in der Regel chirurgisch über ein Debridement und den Wechsel der mobilen Teile adressiert werden können, muss bei chronischen Infektionen nahezu immer ein kompletter Wechsel des Implantates erfolgen. Dies kann je nach Allgemeinzustand des Patienten, dem Erreger und den Resistenzen sowie der Wundverhältnisse ein- oder zweizeitig erfolgen. Der chirurgischen Revision schließt sich in jedem Fall eine resistenzgerechte Antibiose an, deren Therapiedauer durch unterschiedliche Faktoren bestimmt wird.
Sections du résumé
BACKGROUND
BACKGROUND
Septic revision arthroplasty represents an interdisciplinary challenge in terms of diagnosis as well as surgical and follow-up treatment.
DIAGNOSIS
METHODS
The implementation of a standardized diagnostic algorithm including anamnesis, clinic, imaging, blood sampling and joint aspiration is essential. Depending on the duration of the symptoms acute (< 3 weeks) and chronic (> 3 weeks) infections are distinguished.
THERAPY
METHODS
While acute infections show an immature biofilm and can usually be addressed surgically via debridement and changing the mobile parts, chronic infections almost always require a complete change of the implant. This can be done in one or two stages, depending on the general condition of the patient, the pathogen, its resistances as well as the wound conditions. The surgical revision is always followed by a resistance-based antibiotic treatment.
ZUSAMMENFASSUNG
UNASSIGNED
HINTERGRUND: Die septische Revisionsendoprothetik stellt in ihrer Diagnostik, Durchführung und Nachbehandlung eine interdisziplinäre Herausforderung dar.
DIAGNOSE
METHODS
Zur Sicherung der Diagnose muss das Abarbeiten eines standardisierten Algorithmus erfolgen: Anamnese, Klinik, Bildgebung, Blutentnahme und Gelenkpunktion sind die diagnostischen Grundpfeiler. Letztere sollte immer die Bestimmung der Leukozytenzahl, die Bestimmung der neutrophilen Granulozyten und eine mikrobiologische Untersuchung des Punktats umfassen. Abhängig von der Dauer der angegebenen Beschwerden unterscheidet man klinisch zwischen akuten (< 3 Wochen) und chronischen (> 3 Wochen) Infekten.
THERAPIE
UNASSIGNED
Während akute Infektionen einen unreifen Biofilm aufweisen und in der Regel chirurgisch über ein Debridement und den Wechsel der mobilen Teile adressiert werden können, muss bei chronischen Infektionen nahezu immer ein kompletter Wechsel des Implantates erfolgen. Dies kann je nach Allgemeinzustand des Patienten, dem Erreger und den Resistenzen sowie der Wundverhältnisse ein- oder zweizeitig erfolgen. Der chirurgischen Revision schließt sich in jedem Fall eine resistenzgerechte Antibiose an, deren Therapiedauer durch unterschiedliche Faktoren bestimmt wird.
Autres résumés
Type: Publisher
(ger)
HINTERGRUND: Die septische Revisionsendoprothetik stellt in ihrer Diagnostik, Durchführung und Nachbehandlung eine interdisziplinäre Herausforderung dar.
Identifiants
pubmed: 34652467
doi: 10.1007/s00132-021-04176-8
pii: 10.1007/s00132-021-04176-8
doi:
Substances chimiques
Anti-Bacterial Agents
0
Types de publication
Journal Article
Review
Langues
ger
Sous-ensembles de citation
IM
Pagination
995-1003Informations de copyright
© 2021. Springer Medizin Verlag GmbH, ein Teil von Springer Nature.
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