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[Implant-associated joint infections].

Heinrich M L Mühlhofer1, Susanne Feihl2, Christian Suren3

  • 1Klinik und Poliklinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland. heinrich.muehlhofer@tum.de.

Der Orthopade
|February 26, 2020
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Summary

Periprosthetic joint infections are increasing, requiring careful diagnosis and treatment. Differentiating between mature and immature biofilms guides surgical and antibiotic strategies for successful outcomes.

Keywords:
Anti-infective treatmentBiofilmPeriprosthetic infectionRevision surgerySurgical treatment

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Area of Science:

  • Orthopedics
  • Infectious Diseases
  • Biomaterials Science

Background:

  • Increasing rates of endoprosthetic joint replacements, particularly in elderly and comorbid patients, lead to a rise in revision surgeries due to infections.
  • Periprosthetic joint infection (PJI) presents a complex clinical challenge, demanding specialized diagnostic and therapeutic approaches.
  • The presence of mature or immature biofilms on implant surfaces significantly influences treatment strategies for PJI.

Purpose of the Study:

  • To provide a comprehensive overview of managing periprosthetic joint infections.
  • To detail diagnostic methodologies and decision-making processes for PJI treatment.
  • To differentiate treatment concepts based on biofilm maturity.

Main Methods:

  • Review of current literature and clinical guidelines on periprosthetic joint infection diagnosis and management.
  • Analysis of treatment strategies based on infection acuity (acute vs. low-grade) and biofilm characteristics.
  • Emphasis on the integration of diagnostic findings, surgical intervention, and antimicrobial therapy.

Main Results:

  • Periprosthetic infections require a nuanced approach, distinguishing between acute and low-grade presentations.
  • Biofilm maturity (mature vs. immature) is a critical factor in selecting appropriate treatment modalities.
  • Successful management hinges on the synergistic application of prompt diagnosis, adequate surgical debridement or revision, and tailored anti-infective therapy.

Conclusions:

  • Effective treatment of periprosthetic joint infections necessitates a multidisciplinary approach.
  • Timely diagnosis and appropriate surgical intervention are paramount, especially in acute cases, which constitute an orthopedic emergency.
  • Individualized anti-infective treatment, guided by biofilm assessment, is crucial for optimizing patient outcomes and minimizing revision rates.