[Infections during joint replacement under immunomodulatory treatment]

Artificial joint replacement, particularly of the hip and knee joints, has become an established treatment option for degenerative and systemic inflammatory joint diseases in Germany; however, with the increasing number of endoprosthetic procedures, the risk of postoperative complications, particularly periprosthetic infections (PPI), also increases. These infections can lead to severe consequences, such as prolonged healing times, redo surgery and functional impairments. Patients with rheumatic diseases and immunosuppressive treatment have a particularly high risk for PPI, as the immune response is severely impaired by medications, such as corticosteroids, disease-modifying antirheumatic drugs (DMARD) and biologics. Preoperative measures, such as a thorough anamnesis and adjustment of the immunosuppressive treatment, are crucial to minimize the risk of infections. Diagnosing a PPI in immunosuppressed patients can be challenging as typical symptoms are often less pronounced. In cases of a suspected infection, an early diagnostic work-up and individualized treatment are required, which may include both antibiotic treatment and surgical interventions. An interdisciplinary management involving rheumatologists, orthopedic (rheumatologic) surgeons and infectious disease specialists is essential for successful treatment. Preventive strategies and targeted perioperative risk management can help to reduce the occurrence of PPI and ensure the long-term health of patients.