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DOI: 10.1055/s-0038-1628298
Das Problem der Osteitis bei der periprothetischen Gelenkinfektion
The problem of osteomyelitis in periprosthetic joint infectionPublication History
eingegangen:
04 September 2017
angenommen:
22 September 2017
Publication Date:
24 January 2018 (online)
Zusammenfassung
Die Therapie der periprothetischen Osteitis im Rahmen einer Endoprotheseninfektion ist nicht nur ein Determinant der vollständigen Sanierung des Situs, sondern auch ein entscheidender Faktor für die Auswahl und Stabilität des Revisionsimplantats. Nach einer nur eingeschränkt möglichen präoperativen bildmorphologischen Detektion von osteitischen Arealen im periimplantären Gewebe ist die gründliche und vor allem radikale Resektion von avitalen, biofilmtragenden Knochensequestern die Grundlage für eine nachhaltige Keimfreiheit des Prothesenlagers. Des weiteren zählen ein adäquates Totraummanagement, z. B. durch antibiotikatragende Spacer, und die hochkonzentrierte systemische Antibiose zu den Grundpfeilern der Osteitistherapie. Der vorliegende Artikel beschreibt die zugrundeliegende Pathophysiologie, bildgebende Diagnostika im Osteitisnachweis und gibt einen Einblick in die zuvor genannten Therapiegrundsätze.
Summary
The therapy of periprosthetic osteomyelitis within the context of periprosthetic infection is not only an essential parameter in complete recovery of the infection site, but also a significant factor of choice and stability of the later revision implant. The preoperative direct imaging of osteomyelitis surrounding the implant is often inconclusive leaving the thourough and radical resection of avital, biofilm-carrying bone sequesters as the base for a sustainable infection free bone stock. Furthermore, an adequate dead space management, e. g. via antibiotic loaded spacers, and a high-dosage, systemic antibiotic treatment constitute a successful therapy of osteomyelitis. The article characterizes the underlying pathophysiology of periprosthetic osteomyelits, shows different imaging options and gives an insight of the principles of therapy.
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