Therapeutische Optionen beim periprothetischen Infekt des Schultergelenks

Zusammenfassung

Für die Behandlung von periprothetischen Infektionen von Schulterendoprothesen existieren verschiedene therapeutische Konzepte. Bei akuten periprothetischen Infektionen kann das Implantat belassen werden, alle mobilen Teile (Inlay) sollten bei einem offenen Débridement gewechselt werden und Spülungen mit antibakteriellen Lösungen wie Octinedin oder Polyhexanid durchgeführt werden. Bei Spätinfektionen sind die therapeutischen Optionen nach der Entfernung des infizierten Implantats: Einlage eines permanent verbleibenden Spacers, die Resektionsarthroplastik, einzeitige und zweizeitige Wechsel mit und ohne temporären Spacer. Die funktionellen Ergebnisse sind beim einzeitigen Wechsel am besten und die Eradikationsrate vergleichbar mit derjenigen beim zweizeitigen Wechsel. Voraussetzung für den einzeitigen Wechsel ist die Identifizierung des Keimes, um zielgerichtete Antibiotika in den Zement beizumischen und systemisch zu verabreichen.

Abstract

There are several therapeutic options for the treatment of periprosthetic joint infections of shoulder arthroplasties. In acute infections, the implant can remain in place with open debridement, septic lavage with antibacterial solutions such as octinedine or polyhexanide solution and exchange of all mobile components. In late infections, the therapeutic options after removal of the infected implant are: permanent spacer, resection arthroplasty, one stage revision and two stage revision with or without a temporary spacer. The functional results are best for one stage revisions, with similar prosthetic survival to two stage revisions. For one stage revisions, the microorganism has to be identified prior to revision surgery, in order to use targeted antibiotics locally in the cement, and systemically.

Schlüsselwörter

Therapie - periprothetischer Infekt - Schulterendoprothese

Key words

periprosthetic infection - therapy - shoulder arthroplasty

• Literatur

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