Kirschbaum Stephanie, Perka Carsten
Centrum für Muskuloskeletale Chirurgie, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland.
Orthopade. 2021 Dec;50(12):995-1003. doi: 10.1007/s00132-021-04176-8. Epub 2021 Oct 15.
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.
感染性关节置换翻修术在诊断以及手术和后续治疗方面是一项跨学科挑战。
实施包括病史、临床症状、影像学检查、血液采样和关节穿刺的标准化诊断算法至关重要。根据症状持续时间区分急性（<3周）和慢性（>3周）感染。
急性感染表现为生物膜不成熟，通常可通过清创和更换活动部件进行手术处理，而慢性感染几乎总是需要完全更换植入物。这可根据患者的一般状况、病原体、其耐药性以及伤口情况分一或两个阶段进行。手术翻修后始终要进行基于耐药性的抗生素治疗。
