Diagnostik und Therapie periprothetischer Gelenkinfektionen in Deutschland – Eine Umfrage an 450 Kliniken und Vergleich mit der aktuellen Literatur

Zusammenfassung

Die Diagnostik und Therapie der periprothetischen Gelenkinfektion stellt den behandelnden Arzt vor eine schwierige Aufgabe. Aus der umfassenden Literatur lassen sich Algorithmen zur Diagnostik und Therapie erstellen. Ziel der Arbeit war es, in einer repräsentativen Umfrage die aktuellen Konzepte in den alten Bundesländern zu erfassen und mit der aktuellen Literatur zu vergleichen. 2011 wurden orthopädische und unfallchirurgische Kliniken in den alten Bundesländern zum Thema Diagnostik und Therapie des periprothetischen Infekts anonym befragt. 450 Fragebögen konnten ausgewertet werden. Septische Hüftprotheseneingriffe wurden im Durchschnitt 12 (± 20)/Jahr, septische Knieprotheseneingriffe wurden im Durchschnitt 9 (± 17)/Jahr durchgeführt. Im Mittel wurden 205 (± 178) primäre Hüft- und 167 (± 155) primäre Knieendoprothesen im Jahr implantiert. Die Auswertung der erhobenen Parameter ist in 3 Tabellen zusammengefasst. Im Bereich der Diagnostik werden einzelne Parameter wie z. B. das CRP bestimmt, die Interpretation weicht jedoch in über 50 % der Kliniken von der relevanten Literatur ab. Einige wichtige diagnostische Parameter werden nicht genutzt. In der Therapie besteht weitestgehend Übereinstimmung mit der Literatur. Die in einem nicht unerheblichen Maße angewandte V. A. C.-Therapie (ca. 30 % der Kliniken) ist lediglich im Frühinfekt beschrieben. Aber auch zur Anwendung im Frühinfekt liegen nur sehr wenige Daten vor. Ein einheitlicher Algorithmus zur Diagnostik wäre wünschenswert.

Abstract

The diagnosis and treatment of periprosthetic joint infections is a difficult situation for the attending physician. From the extensive literature, algorithms for diagnosis and therapy can be created. The aim of this study was to collect a representative survey of current concepts in the Federal States of the former West Germany and to compare them with those in the current literature. In 2011 orthopaedic and trauma clinics were surveyed anonymously in western Germany about diagnosis and treatment of periprosthetic infections. 450 questionnaires could be evaluated. Septic hip arthroplasty revisions were performed on average 12 (± 20)/year, septic knee arthroplasty revisions were performed on average 9 (± 17)/year. On average 205 (± 178) primary hip and 167 (± 155) primary knee arthroplasties were implanted/year. The analysis of the collected parameters is summarised in three tables. In the field of diagnostics, parameters such as CRP are determined. The interpretation, however, differs in more than 50 % of the hospitals on the relevant literature. Some important diagnostic parameters are not used. Therapy concepts are largely consistent with the literature. To a non-negligible extent, the vacuum-assisted therapy (approximately 30 % of hospitals) is used. In the literature it is described only for early infection. But even for use in early infection, there are very few data available. A unified diagnostic algorithm would be desirable.

Schlüsselwörter

periprothetische Gelenkinfektion - septische Hüftprotheseneingriffe - septische Knieprotheseneingriffe - V. A. C.-Therapie - Diagnostik - Therapie

Key words

periprosthetic infection - revision hip arthroplasty - revision knee arthroplasty - vacuum-assisted therapy - diagnostics - therapy

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