[Diagnosis and treatment of foreign-body-associated infection in orthopaedic surgery].
Periprosthetic infection is a foreign-body-associated infection that is characterised by delayed osteomyelitis of bone tissue surrounding artificial joint replacement. Most of these infections result from intraoperative bacterial contamination of the prosthetic device implanted. The period from contamination to clinically apparent infection can last months or even years. In these cases, the initial surgical procedure is often not blamed for the actual infection. Moreover, these infections often produce minimal symptoms that can be mistaken for aseptic loosening of the artificial joint replacement. The bacterial burden of the causative pathogen is low in these cases, a fact that need to be considered in the diagnostic procedures.Knowledge of the pathogenesis allows the orthopaedic surgeon to plan the diagnostic procedures and therapy as well. In this context, the pathogen's ability to form biofilm is of crucial significance and explains why it is necessary to remove the foreign body (prosthesis or other artificial devices, such as material used for osteosynthesis or spinal stabilisation) to control this type of infection. This article gives some basic information for better understanding of foreign-body-associated infection in order to improve diagnostics and therapy in the clinical routine.
Frommelt
L
L
Service für Infektiologie, Klinische Mikrobiologie und Krankenhaushygiene, ENDO-Klinik Hamburg GmbH, Holstenstrasse 2, 22767, Hamburg, Deutschland. lars.frommelt@t-online.de
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D018441:Biofilms / Q000254:growth & development; D001706:Biopsy; D002908:Chronic Disease; D003131:Combined Modality Therapy; D003937:Diagnosis, Differential; D024901:Drug Resistance, Multiple, Bacterial; D006622:Hip Prosthesis / Q000382:microbiology*; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood; D007720:Knee Prosthesis / Q000382:microbiology*; D010019:Osteomyelitis / Q000175:diagnosis / Q000382:microbiology / Q000628:therapy; D011237:Predictive Value of Tests; D011475:Prosthesis Failure; D016459:Prosthesis-Related Infections / Q000175:diagnosis* / Q000382:microbiology / Q000628:therapy*; D012086:Reoperation
D000900:Anti-Bacterial Agents; D018836:Inflammation Mediators