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Infekt nach Arthroskopie

Infection after arthroscopy

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Zusammenfassung

Einleitung

Die postarthroskopische Gelenkinfektion stellt ein sehr seltenes Ereignis dar. Da jedoch die verspätete Diagnosestellung dramatische Folgen haben kann, ist eine frühe genaue Anamneseerhebung, Laboruntersuchungen und insbesondere die diagnostische Punktion oder bei klinisch hochgradigem Infektverdacht die intraoperative Probenentnahme (ohne vorherige Antibiotikagabe) notwendig.

Methoden

In früheren Infektstadien hat sich die arthroskopische Therapie bewährt. Die kalkulierte und dann antibiogrammgerechte antibiotische Therapie ist wichtiger Bestandteil des Therapiekonzepts. Einen Sonderfall stellen die implantatassoziierten Gelenkinfekte dar, die oft eine aufwändigere operative Therapie mit längerer Antibiotikagabe und Entscheidungen hinsichtlich Implantaterhalt oder -entfernung notwendig machen. In diesem Zusammenhang sollte dringend die interdisziplinäre Zusammenarbeit mit Infektiologen angestrebt werden.

Schlussfolgerung

Bei bestehenden Infektzeichen muss die Indikation zur operativen Revision rasch und großzügig gestellt werden. Um einer postoperativen Gelenksteife vorzubeugen, sollte die frühzeitige Mobilisation des Gelenks erfolgen und die Immobilisationsdauer so kurz wie möglich gehalten werden.

Abstract

Introduction

Postarthroscopy infections are rare. Because delayed diagnosis can have dramatic consequences, an early enquiry of patient history, blood examinations, and diagnostic puncture or—in case of strong suspicion of infection—intraoperative sampling (without previous antibiotics) is necessary.

Methods

For early-stage infections, arthroscopic therapy has proven valuable. In addition, calculated and antibiogram-adjusted antibiotic therapy is essential. A special case is implant-associated joint infection, which requires a more complex surgical therapy with often longer antibiotic treatment and decisions concerning implant preservation or removal. In this context, interdepartmental cooperation is desired.

Conclusion

If signs of infection are present, the indication for surgical revision should be considered quickly and comprehensively. To prevent joint stiffness, mobilization should be started early and the duration of immobilization should be kept as short as possible.

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Literatur

  1. 1.

    (Peg) P-E-Gfcev (2010) Perioperative Antibiotika-Prophylaxe. Empfehlungen einer Expertenkommission. Chemother J 19:15

  2. 2.

    Aggarwal VK, Tischler E, Ghanem E et al (2013) Leukocyte esterase from synovial fluid aspirate: a technical note. J Arthroplasty 28:193–195

  3. 3.

    Armstrong RW, Bolding F, Joseph R (1992) Septic arthritis following arthroscopy: clinical syndromes and analysis of risk factors. Arthroscopy 8:213–223

  4. 4.

    Arthroskopie S-Sffd (2005) Diagnostik und arthroskopische Therapie von Gelenksinfekten

  5. 5.

    Ateschrang A, Albrecht D, Schroeter S et al (2011) Current concepts review: septic arthritis of the knee pathophysiology, diagnostics, and therapy. Wien Klin Wochenschr 123:191–197

  6. 6.

    Athwal GS, Sperling JW, Rispoli DM et al (2007) Deep infection after rotator cuff repair. J Shoulder Elbow Surg 16:306–311

  7. 7.

    Awmf (1999) Perioperative Antibiotikaprophylaxe. Leitlinie 029–022

  8. 8.

    Babcock HM, Carroll C, Matava M et al (2003) Surgical site infections after arthroscopy: outbreak investigation and case control study. Arthroscopy 19:172–181

  9. 9.

    Babcock HM, Matava MJ, Fraser V (2002) Postarthroscopy surgical site infections: review of the literature. Clin Infect Dis 34:65–71

  10. 10.

    Balabaud L, Gaudias J, Boeri C et al (2007) Results of treatment of septic knee arthritis: a retrospective series of 40 cases. Knee Surg Sports Traumatol Arthrosc 15:387–392

  11. 11.

    Bottner F, Wegner A, Winkelmann W et al (2007) Interleukin-6, procalcitonin and TNF-alpha: markers of peri-prosthetic infection following total joint replacement. J Bone Joint Surg Br 89:94–99

  12. 12.

    Buehler M, Engelhardt M, Schmidt HGK (2003) Septische postoperative Komplikationen. In: Atlas für Unfallchirurgie und Orthopädie. Springer, Berlin

  13. 13.

    Clarke MT, Arora A, Villar RN (2003) Hip arthroscopy: complications in 1054 cases. Clin Orthop Relat Res 84–88

  14. 14.

    Classen DC, Evans RS, Pestotnik Sl et al (1992) The timing of prophylactic administration of antibiotics and the risk of surgical-wound infection. N Engl J Med 326:281–286

  15. 15.

    Darley ES, Macgowan AP (2004) Antibiotic treatment of gram-positive bone and joint infections. J Antimicrob Chemother 53:928–935

  16. 16.

    Donatto KC (1998) Orthopedic management of septic arthritis. Rheum Dis Clin North Am 24:275–286

  17. 17.

    Esterhai JL Jr, Gelb I (1991) Adult septic arthritis. Orthop Clin North Am 22:503–514

  18. 18.

    Gächter A (1985) Der Gelenkinfekt. Inform Arzt 6:9

  19. 19.

    Geipel U, Herrmann M (2004) The infected implant. Part 1: bacteriology. Orthopade 33:1411–1426, 1427–1418

  20. 20.

    Goldenberg DL (1998) Septic arthritis. Lancet 351:197–202

  21. 21.

    Grifka J, Kuster MS (2011) Orthopädie und Unfallchirurgie. Springer-Verlag, Berlin

  22. 22.

    Hauer T, Tabori E (2008) Perioperative Antibiotikaprophylaxe (PAP). Arthroskopie 21:3

  23. 23.

    Hepburn MJ, Fraser SL, Rennie TA et al (2003) Septic arthritis caused by Granulicatella adiacens: diagnosis by inoculation of synovial fluid into blood culture bottles. Rheumatol Int 23:255–257

  24. 24.

    Jeon IH, Choi CH, Seo JS et al (2006) Arthroscopic management of septic arthritis of the shoulder joint. J Bone Joint Surg Am 88:1802–1806

  25. 25.

    Jerosch J (1999) Arthroscopic ankle surgery. Indications, methods, results, complications. Orthopade 28:538–549

  26. 26.

    Jerosch J (2006) Erkennung und Behandlung von Infektionen nach arthroskopischen Eingriffen. Arthroskopie 19:9

  27. 27.

    Johnson Ll, Shneider DA, Austin MD et al (1982) Two per cent glutaraldehyde: a disinfectant in arthroscopy and arthroscopic surgery. J Bone Joint Surg Am 64:237–239

  28. 28.

    Kelly PJ, Martin WJ, Coventry MB (1970) Bacterial (suppurative) arthritis in the adult. J Bone Joint Surg Am 52:1595–1602

  29. 29.

    Kirchhoff C, Braunstein V, Buhmann Kirchhoff S et al (2009) Stage-dependant management of septic arthritis of the shoulder in adults. Int Orthop 33:1015–1024

  30. 30.

    Kuner EH, Thurck HU, Von Der Lippe I (1987) Diagnosis and therapy of acute infections of the knee joint. Unfallchirurgie 13:249–254

  31. 31.

    Kwon YW, Kalainov DM, Rose HA et al (2005) Management of early deep infection after rotator cuff repair surgery. J Shoulder Elbow Surg 14:1–5

  32. 32.

    Lane JG, Falahee MH, Wojtys EM et al (1990) Pyarthrosis of the knee. Treatment considerations. Clin Orthop Relat Res 198–204

  33. 33.

    Lob G, Burri C (1987) Causes and pathophysiology of infection of the knee joint. Unfallchirurgie 13:233–240

  34. 34.

    Lungershausen W, Markgraf E, Dorow C et al (1998) Joint empyema. Chirurg 69:828–835

  35. 35.

    Margaretten ME, Kohlwes J, Moore D et al (2007) Does this adult patient have septic arthritis? JAMA 297:1478–1488

  36. 36.

    Masgala A, Chronopoulos E, Nikolopoulos G et al (2012) Risk factors affecting the incidence of infection after orthopaedic surgery: the role of chemoprophylaxis. Cent Eur J Public Health 20:252–256

  37. 37.

    Mathews CJ, Coakley G (2008) Septic arthritis: current diagnostic and therapeutic algorithm. Curr Opin Rheumatol 20:457–462

  38. 38.

    Mathews CJ, Weston VC, Jones A et al (2010) Bacterial septic arthritis in adults. Lancet 375:846–855

  39. 39.

    Maurer TB, Ochsner PE (2006) Infected knee arthroplasty. A treatment algorithm at the Kantonsspital Liestal, Switzerland. Orthopade 35:917–918, 920–918

  40. 40.

    Mcallister DR, Parker RD, Cooper AE et al (1999) Outcomes of postoperative septic arthritis after anterior cruciate ligament reconstruction. Am J Sports Med 27:562–570

  41. 41.

    Mehta P, Schnall SB, Zalavras CG (2006) Septic arthritis of the shoulder, elbow, and wrist. Clin Orthop Relat Res 451:42–45

  42. 42.

    Müller-Rath R, Becker J, Ingenhoven E (2008) Wie hoch ist das statistische Risiko einer Infektion nach ambulanter Arthroskopie? Arthroskopie 21:5

  43. 43.

    Oestern S, Varoga D, Trompetter R et al (2013) Knee joint infections. Unfallchirurg 116:255–268 (quiz 269–270)

  44. 44.

    Orchard RA, Stamp WG (1968) Early treatment of induced suppurative arthritis in rabbit knee joints. Clin Orthop Relat Res 59:287–293

  45. 45.

    Paul J, Kirchhoff C, Imhoff AB et al (2008) Infection after arthroscopy. Orthopade 37:1048, 1050–1042, 1054–1045

  46. 46.

    Petersen W, Zantop T (2009) Das vordere Kreuzband. Grundlagen und aktuelle Praxis der operativen Therapie. Deutscher Ärzteverlag, Köln

  47. 47.

    Pioro MH, Mandell BF (1997) Septic arthritis. Rheum Dis Clin North Am 23:239–258

  48. 48.

    Salter RB (1989) The biologic concept of continuous passive motion of synovial joints. The first 18 years of basic research and its clinical application. Clin Orthop Relat Res 12–25

  49. 49.

    Schiesser M, Stumpe KD, Trentz O et al (2003) Detection of metallic implant-associated infections with FDG PET in patients with trauma: correlation with microbiologic results. Radiology 226:391–398

  50. 50.

    Schub Dl, Schmitz LM, Sakamoto FA et al (2012) Long-term outcomes of postoperative septic arthritis after anterior cruciate ligament reconstruction. Am J Sports Med 40:2764–2770

  51. 51.

    Simank HG, Wadi B, Bernd L (2004) Joint empyema. Orthopade 33:327–331

  52. 52.

    Smith JW, Piercy EA (1995) Infectious arthritis. Clin Infect Dis 20:225–230 (quiz 231)

  53. 53.

    Spangehl MJ, Masri BA, O’connell JX et al (1999) Prospective analysis of preoperative and intraoperative investigations for the diagnosis of infection at the sites of two hundred and two revision total hip arthroplasties. J Bone Joint Surg Am 81:672–683

  54. 54.

    Strecker W, Eisele R, Fritz M et al (2005) Value of arthroscopy in the treatment of upper ankle arthritis. Unfallchirurg 108:461–469

  55. 55.

    Stutz G, Gachter A (2001) Diagnosis and stage-related therapy of joint infections. Unfallchirurg 104:682–686

  56. 56.

    Stutz G, Kuster MS, Kleinstuck F et al (2000) Arthroscopic management of septic arthritis: stages of infection and results. Knee Surg Sports Traumatol Arthrosc 8:270–274

  57. 57.

    Tabori NE (2008) Druchblick bei der Hygiene. Arthroskopie 21:8

  58. 58.

    Torres-Claramunt R, Pelfort X, Erquicia J et al (2012) Knee joint infection after ACL reconstruction: prevalence, management and functional outcomes. Knee Surg Sports Traumatol Arthrosc

  59. 59.

    Trampuz A, Borens O (2013) Biofilminfektionen: Eine Herausforderung für die moderne Medizin. In: Universimed (Hrsg) Orthopädie & Unfallchirurgie

  60. 60.

    Trampuz A, Hanssen AD, Osmon DR et al (2004) Synovial fluid leukocyte count and differential for the diagnosis of prosthetic knee infection. Am J Med 117:556–562

  61. 61.

    Trampuz A, Osmon DR, Hanssen AD et al (2003) Molecular and antibiofilm approaches to prosthetic joint infection. Clin Orthop Relat Res 69–88

  62. 62.

    Trampuz A, Piper KE, Jacobson MJ et al (2007) Sonication of removed hip and knee prostheses for diagnosis of infection. N Engl J Med 357:654–663

  63. 63.

    Trampuz A, Widmer AF (2006) Infections associated with orthopedic implants. Curr Opin Infect Dis 19:349–356

  64. 64.

    Trampuz A, Zimmerli W (2006) Diagnosis and treatment of infections associated with fracture-fixation devices. Injury 37(Suppl 2):S59–S66

  65. 65.

    Vincent GM, Amirault JD (1990) Septic arthritis in the elderly. Clin Orthop Relat Res 241–245

  66. 66.

    Vispo Seara JL, Barthel T, Schmitz H et al (2002) Arthroscopic treatment of septic joints: prognostic factors. Arch Orthop Trauma Surg 122:204–211

  67. 67.

    Wick M, Muller EJ, Ambacher T et al (2003) Arthrodesis of the shoulder after septic arthritis. Long-term results. J Bone Joint Surg Br 85:666–670

  68. 68.

    Widmer AF (2001) New developments in diagnosis and treatment of infection in orthopedic implants. Clin Infect Dis 33(Suppl 2):S94–S106

  69. 69.

    Worsdorfer O, Fleischmann W (1990) Irrigation drainage in local treatment of infection of bones and joints. Aktuelle Probl Chir Orthop 34:55–64

  70. 70.

    Zimmerli W, Trampuz A, Ochsner PE (2004) Prosthetic-joint infections. N Engl J Med 351:1645–1654

  71. 71.

    Zimmerli W, Waldvogel FA, Vaudaux P et al (1982) Pathogenesis of foreign body infection: description and characteristics of an animal model. J Infect Dis 146:487–497

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Einhaltung ethischer Richtlinien

Interessenkonflikt. A.B. Imhoff, K. Schumann, S. Buchmann, J. Paul geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag enthält keine Studien an Menschen oder Tieren.

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Correspondence to Prof. Dr. A.B. Imhoff.

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Schumann, K., Buchmann, S., Paul, J. et al. Infekt nach Arthroskopie. Arthroskopie 26, 259–266 (2013). https://doi.org/10.1007/s00142-013-0761-0

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Schlüsselwörter

  • Gelenkifekt
  • Arthroskopie
  • Risiken
  • Stadien
  • Therapie

Keywords

  • Joint infection
  • Arthroscopy
  • Risks
  • Stages
  • Therapy