[Structured approach for infected prosthesis]

Area of Science:

• Orthopedics
• Infectious Diseases
• Biomedical Engineering

Context:

• Endoprosthesis infections pose a significant challenge, with increasing incidence due to aging populations and more implantations.
• Effective infection control is vital, particularly for geriatric and multimorbid patients, to mitigate high mortality rates.

Purpose:

• To present a structured, evidence-based algorithm for managing endoprosthesis infections.
• To outline diagnostic and therapeutic strategies for early and late prosthesis infections.
• To emphasize the importance of interdisciplinary collaboration in optimizing patient outcomes.

Summary:

• Prosthesis infections are classified as early or late ( $>30$ days post-implantation).
• Diagnosis involves clinical assessment, imaging (X-ray, CT), laboratory tests (CRP, leukocytes), and microbiology (synovial fluid analysis).
• Treatment strategies include surgical debridement, biofilm removal, and tailored antibiotic therapy, potentially involving temporary explantation or antibiotic-eluting spacers. Prosthesis preservation via debridement, antibiotics, and implant retention (DAIR) is suitable for acute infections.

Impact:

• A structured algorithmic approach improves healing possibilities for prosthesis infections.
• Interdisciplinary cooperation between orthopedic surgeons and infectious disease specialists enhances treatment efficacy.
• Surgical intervention to reduce bacterial load and eradicate biofilms, coupled with appropriate antibiotic treatment, is fundamental for successful management.