Janz V, Löchel J, Trampuz A, Schaser K-D, Hofer A, Wassilew G I
Klinik und Poliklinik für Orthopädie und Orthopädische Chirurgie, Universitätsmedizin Greifswald KöR, Sauerbruchstr., 17475, Greifswald, Deutschland.
Centrum für Muskuloskelettale Chirurgie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland.
Orthopade. 2020 Feb;49(2):142-148. doi: 10.1007/s00132-020-03872-1.
Periprosthetic joint infection (PJI) of megaprostheses occur in about 10% of all cases. The criteria for PJI are defined by the "Musculoskleletal Infection Society" (MSIS) and apply to both primary arthroplasty and megaprostheses.
The management strategies of PJI in megaprostheses are dependent on the duration of infection and the maturity of the bacterial biofilm. Implant retention with an exchange of the mobile components is only possible in the presence of an immature biofilm. In the presence of a mature biofilm, a one- or two-stage exchange must be performed. A complete exchange of all endoprosthetic components should be performed, if possible, since a partial retention of isolated components results in inferior treatment success rates.
The highest success rates are achievable with two-stage exchanges. Multiple risk factors such as skin necrosis, postoperative haematoma, prolonged wound secretion and operative times ≥ 2.5 h are risk factors for the development of PJI in megaprostheses. Knowledge regarding these risk factors allows for an identification of high-risk patients and early management of PJI.
大型假体周围关节感染（PJI）在所有病例中约占10%。PJI的诊断标准由“肌肉骨骼感染协会”（MSIS）定义，适用于初次关节置换术和大型假体。
大型假体PJI的处理策略取决于感染持续时间和细菌生物膜的成熟度。仅在生物膜不成熟时才可能保留假体并更换活动部件。在生物膜成熟的情况下，必须进行一期或二期翻修。如果可能，应彻底更换所有假体组件，因为部分保留单个组件会导致治疗成功率较低。
二期翻修可获得最高成功率。多种风险因素，如皮肤坏死、术后血肿、伤口分泌物持续时间延长和手术时间≥2.5小时，是大型假体发生PJI的风险因素。了解这些风险因素有助于识别高危患者并对PJI进行早期处理。
