[Therapy and results of infections of the large joints without bone injuries using septopal]

Bacterial infection of major joints is an accident surgery emergency requiring immediate treatment by wide opening, meticulous debridement, insertion of Septopal and short-term systemic treatment with antibiotics. In case of pronounced exsudative joint infection two surgical procedures are necessary: initial surgery leaves arthrotomy open to prevent any possible retention, whereas in a second procedure about 10 days later the open wounds are subjected to secondary closure after repeating the debridement. Early functional treatment, which is decisive for the ultimate joint function, can be initiated in each case directly after surgery. Prognosis of joint function depends on the time at which consequent therapy is initiated. In 13 joint infections with early or delayed onset of treatment at our hospital during 1980 to 1984, all infections were permanently cleared with good joint function without requiring any subsequent surgery or revision. Primary (in one case secondary) arthrodeses were required in six chronic joint infections with late onset of treatment. Since 17 of the 19 joint infections were referred to us after unsatisfactory pretreatment, we can emphasise the fact that in our opinion it will be unsatisfactory to treat joint infections either with antibiotics only or by systemic antibiotic treatment combined with local instillation of antibiotics, punctures or local rinsing, as well as by percutaneously applied closed through-drainage and suction drainage.