Prävention und Diagnostik von periprothetischen Infektionen

Die periprothetische Infektion ist eine schwerwiegende Komplikation im Bereich der Endoprothetik, die nur sehr aufwendig saniert werden kann. Neben der Prävention ist die Kenntnis über eine effiziente Diagnostik entscheidend für den Erfolg der Therapie. In diesem Beitrag wird die aktuelle Empfehlung zur Prävention vor elektiver endoprothetischer Versorgung und die Diagnostik einer periprothetischen Infektion unter Berücksichtigung der Empfehlungen des International Consensus Meeting 2018 zusammengefasst.

Schlüsselwörter

Endoprothetik - periprothetische Infektion - Erregernachweis - Hüftgelenksprothese - Kniegelenksprothese

• Literatur

• 1 Boese CK, Lechler P, Frink M. et al. Cost-analysis of inpatient and outpatient parenteral antimicrobial therapy in orthopaedics: A systematic literature review. World J Clin Cases 2019; 7: 1825-1836
• 2 Pulido L, Ghanem E, Joshi A. et al. Periprosthetic joint infec- tion: the incidence, timing, and predisposing factors. Clin Orthop Relat Res 2008; 466: 1710-1715
• 3 Kurtz S, Ong K, Lau E. et al. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg 2007; 89: 780-785
• 4 Corvec S, Portillo ME, Pasticci BM. et al. Epidemiology and new developments in the diagnosis of prosthetic joint infection. Int J Artif Organs 2012; 35: 923-934
• 5 Zmistowski B, Karam JA, Durinka JB. et al. Periprosthetic joint infection increases the risk of one-year mortality. J Bone Joint Surg Am 2013; 95: 2177-2184
• 6 Haak T, Palitzsch K. Diabetologie für die Praxis. Teil B Toolbox: 22 Diabetes mellitus und OP-Vorbereitung (perioperative Betreuung). Stuttgart: Thieme; 2012
• 7 Cizmic Z, Feng JE, Huang R. et al. Hip and Knee Section, Prevention, Host Related: Proceedings of International Consensus on Orthopedic Infections. J Arthroplast 2019; 34 (2S): S255-S270
• 8 Mraovic B, Suh D, Jacovides C. et al. Perioperative hyperglycemia and postoperative infection after lower limb arthroplasty. J Diabetes Sci Technol 2011; 5: 412-418
• 9 Ellsworth B, Kamath AF. Malnutrition and total joint arthroplasty. J Nat Sci 2016; 2: e179
• 10 Courtney PM, Rozell JC, Melnic CM. et al. Effect of malnutrition and morbid obesity on complication rates following primary total joint arthroplasty. J Surg Orthop Adv 2016; 25: 99-104
• 11 Yi PH, Frank RM, Vann E. et al. Is potential malnutrition associated with septic failure and acute infection after revision total joint arthroplasty?. Clin Orthop Relat Res 2015; 473: 175-182
• 12 Harris CL, Fraser C. Malnutrition in the institutionalized elderly: the effects on wound healing. Ostomy Wound Manage 2004; 50: 54-63
• 13 Greenky Ba M, Gandhi K, Pulido L. et al. Preoperative anemia in total joint arthroplasty: is it associated with periprosthetic joint infection?. Clin Orthop Relat Res 2012; 470: 2695-2701
• 14 Werner BC, Higgins MD, Pehlivan HC. et al. Super obesity is an independent risk factor for complications after primary total hip arthroplasty. J Arthroplasty 2017; 32: 402-406
• 15 Kildow BJ, Agaba P, Moore BF. et al. Postoperative impact of diabetes, chronic kidney disease, hemodialysis, and renal transplant after total hip arthroplasty. J Arthroplasty 2017; 32: S135-S140.e1
• 16 Cavanaugh PK, Chen AF, Rasouli MR. et al. Total joint arthroplasty in transplant recipients: in-hospital adverse outcomes. J Arthroplasty 2015; 30: 840-845
• 17 Kuo SJ, Huang PH, Chang CC. et al. Hepatitis B virus infection is a risk factor for periprosthetic joint infection among males after total knee arthroplasty. Medicine 2016; 95: e3806
• 18 Kildow BJ, Politzer CS, DiLallo M. et al. Short and long-term postoperative complications following total joint arthroplasty in patients with human immunodeficiency virus, hepatitis B, or hepatitis C. J Arthroplasty 2018; 33: S86-S92
• 19 Orozco F, Post ZD, Baxi O. et al. Fibrosis in hepatitis C patients predicts complications after elective total joint arthroplasty. J Arthroplasty 2014; 29: 7-10
• 20 Jiang SL, Schairer WW, Bozic KJ. Increased rates of periprosthetic joint infection in patients with cirrhosis undergoing total joint arthroplasty. Clin Orthop Relat Res 2014; 472: 2483-2491
• 21 Boylan MR, Basu N, Naziri Q. et al. Does HIV infection increase the risk of short-term adverse outcomes following total knee arthroplasty?. J Arthroplasty 2015; 30: 1629-1632
• 22 Capogna BM, Lovy A, Blum Y. et al. Infection rate following total joint arthroplasty in the HIV population. J Arthroplasty 2013; 28: 1254-1258
• 23 Bozic KJ, Lau E, Kurtz S. et al. Patient-related risk factors for periprosthetic joint infection and postoperative mortality following total hip arthroplasty in Medicare patients. J Bone Joint Surg Am 2012; 94: 794-800
• 24 Bohl DD, Sershon RA, Fillingham YA. et al. Incidence, risk factors, and sources of sepsis following total joint arthroplasty. J Arthroplasty 2016; 31: 2875-2879.e2
• 25 Pieringer H, Stuby U, Biesenbach G. Patients with rheumatoid arthritis undergoing surgery: how should we deal with antirheumatic treatment?. Semin Arthritis Rheum 2007; 36: 278-286
• 26 Momohara S, Kawakami K, Iwamoto T. et al. Prosthetic joint infection after total hip or knee arthroplasty in rheumatoid arthritis patients treated with nonbiologic and biologic disease-modifying antirheumatic drugs. Mod Rheumatol 2011; 21: 469-475
• 27 Cordtz RL, Zobbe K, Højgaard P. et al. Predictors of revision, prosthetic joint infection and mortality following total hip or total knee arthroplasty in patients with rheumatoid arthritis: a nationwide cohort study using Danish healthcare registers. Ann Rheum Dis 2018; 77: 281-288
• 28 Krueger K, Albrecht K. Rehart S et al. und die Kommission Pharmakotherapie der DGRh. Empfehlungen der Deutschen Gesellschaft für Rheumatologie zur perioperativen Vorgehensweise unter Therapie mit DMARDs und Biologika bei entzündlich-rheumatischen Erkrankungen. Im Internet (Stand: 16.11.2020): https://dgrh.de/dam/jcr:e8ac6b95-3a2f-4113-ab59-da18f1cb7cf4/empfehlungen_periop.pdf
• 29 Cancienne JM, Werner BC, Browne JA. Complications after TKA in patients with hemophilia or Von Willebrandʼs disease. J Arthroplasty 2015; 30: 2285-2289
• 30 Simpson PMS, Brew CJ, Whitehouse SL. et al. Complications of perioperative warfarin therapy in total knee arthroplasty. J Arthroplasty 2014; 29: 320-324
• 31 McDougall CJ, Gray HS, Simpson PM. et al. Complications related to therapeutic anticoagulation in total hip arthroplasty. J Arthroplasty 2013; 28: 187-192
• 32 Ruscher C. Empfehlungen zur Prävention und Kontrolle von Methicillin-resistenten Staphylococcus aureus-Stämmen (MRSA) in medizinischen und pflegerischen Einrichtungen. Bundesgesundheitsbl 2015; 58: 654
• 33 Crowe B, Payne A, Evangelista PJ. et al. Risk factors for infection following total knee arthroplasty: a series of 3836 cases from one institution. J Arthroplasty 2015; 30: 2275-2278
• 34 Hacek DM, Robb WJ, Paule SM. et al. Staphylococcus aureus nasal decolonization in joint replacement surgery reduces infection. Clin Orthop Relat Res 2008; 466: 1349-1355
• 35 Radtke K, Tetzlaff T, Vaske B. et al. Arthroplasty-center related retrospective analysis of risk factors for periprosthetic joint infection after primary and after revision total hip arthroplasty. Technol Health Care 2016; 24: 721-728
• 36 Grammatico-Guillon L, Baron S, Rosset P. et al. Surgical site infection after primary hip and knee arthroplasty: a cohort study using a hospital database. Infect Control Hosp Epidemiol 2015; 36: 1198-1207
• 37 Cordero-Ampuero JJ, De Dios M. What are the risk factors for infection in hemiarthroplasties and total hip arthroplasties?. Clin Orthop Relat Res 2010; 468: 3268-3277
• 38 Padegimas EM, Maltenfort M, Ramsey ML. et al. Periprosthetic shoulder infection in the United States: incidence and economic burden. J Should Elbow Surg 2015; 24: 741-746
• 39 Springer BD. Modifying risk factors for total joint arthroplasty: strategies that work nicotine. J Arthroplasty 2016; 31: 1628-1630
• 40 Singh JA, Schleck C, Harmsen WS. et al. Current tobacco use is associated with higher rates of implant revision and deep infection after total hip or knee arthroplasty: a prospective cohort study. BMC Med 2015; 13: 283
• 41 Crowe B, Payne A, Evangelista PJ. et al. Risk factors for infection following total knee arthroplasty: a series of 3836 cases from one institution. J Arthroplasty 2015; 30: 2275-2278
• 42 Maoz G, Phillips M, Bosco J. et al. The Otto Aufranc Award: modifiable versus nonmodifiable risk factors for infection after hip arthroplasty. Clin Orthop Relat Res 2014; 473: 453-459
• 43 Mills E, Eyawo O, Lockhart I. et al. Smoking cessation reduces postoperative complications: a systematic review and meta-analysis. Am J Med 2011; 124: 144-154.e8
• 44 Kunutsor SK, Whitehouse MR, Blom AW. et al. Patient-related risk factors for periprosthetic joint infection after total joint arthroplasty: a systematic review and meta-analysis. PLoS One 2016; 11: e0150866
• 45 Schairer WW, Nwachukwu BU, Mayman DJ. et al. Preoperative hip injections increase the rate of periprosthetic infection after total hip arthroplasty. J Arthroplasty 2016; 31: 166-169.e1
• 46 Bala A, Penrose CT, Seyler TM. et al. Outcomes after total knee arthroplasty for post-traumatic arthritis. Knee 2015; 22: 630-639
• 47 Pedersen AB, Svendsson JE, Johnsen SP. et al. Risk factors for revision due to infection after primary total hip arthroplasty. A population-based study of 80,756 primary procedures in the Danish Hip Arthroplasty Registry. Acta Orthop 2010; 81: 542-547
• 48 Manrique J, Rasouli MR, Restrepo C. et al. Total knee arthroplasty in patients with retention of prior hardware material: what is the outcome?. Arch Bone Jt Surg 2018; 6: 23-26
• 49 Makridis KG, Obakponovwe O, Bobak P. et al. Total hip arthro- plasty after acetabular fracture: incidence of complications, reoperation rates and functional outcomes: evidence today. J Arthroplasty 2014; 29: 1983-1990
• 50 Pugely AJ, Martin CT. et al. The incidence of and risk factors for 30-day surgical site infections following primary and revision total joint arthroplasty. J Arthroplasty 2015; 30: 47-50
• 51 Cherney DL, Amstutz HC. Total hip replacement in the previously septic hip. J Bone Joint Surg Am 1983; 65: 1256-1265
• 52 Jupiter JB, Karchmer AW, Lowell JD. et al. Total hip arthroplasty in the treatment of adult hips with current or quiescent sepsis. J Bone Joint Surg Am 1981; 63: 194-200
• 53 Aalirezaie A, Arumugam SS, Austin M. et al. Hip and knee section, prevention, risk mitigation: Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty 2019; 34 (2S): S271-S278
• 54 Bekanntmachungen – Amtliche Mitteilungen. Prävention postoperativer Wundinfektionen. Bundesgesundheitsbl 2018; 61: 448-473
• 55 Proceedings of the International Consensus Meeting on Prosthetic Joint Infection 2018. Im Internet (Stand: 16.11.2020): https://icmphilly.com/wp-content/uploads/2018/11/Hip-and-Knee.pdf
• 56 American Academy of Orthopaedic Surgeons. Recommendations for the use of intravenous antibiotic prophylaxis in primary total joint arthro-plasty. 2004. Im Internet: https://www5.aaos.org/uploadedFiles/PreProduction/About/Opinion_Statements/advistmt/1027 Recommendations for the Use of Intravenous Antibiotic Prophylaxis in Primary Total Joint Arthroplasy.pdf
• 57 Anemüller R, Belden K, Brause B. et al. Hip and knee section, treatment, antimicrobials: Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty 2019; 34 (2S): S463-S475
• 58 Kleber C, Trampuz A. Antibiotikaprophylaxe in der Orthopädie und Unfallchirurgie – was, wann und wie lange applizieren?. OP-Journal 2014; 30: 8-10
• 59 Newman ET, Watters TS, Lewis JS. et al. Impact of perioperative allogeneic and autologous blood transfusion on acute wound infection following total knee and total hip arthroplasty. J Bone Joint Surg 2014; 96: 279-284
• 60 Lockhart PB, Brennan MT, Sasser HC. et al. Bacteremia associated with toothbrushing and dental extraction. Circulation 2008; 117: 3118-3125
• 61 Chen A, Haddad F, Lachiewicz P. et al. Prevention of late PJI. J Arthroplasty 2014; 29: 119-128
• 62 Portillo ME, Salvadó M, Alier A. et al. Prosthesis failure within 2 years of implantation is highly predictive of infection. Clin Orthop Relat Res 2013; 471: 3672-3678
• 63 Corvec S, Portillo ME, Pasticci BM. et al. Epidemiology and new developments in the diagnosis of prosthetic joint infection. Int J Artif Organs 2012; 35: 923-934
• 64 Trampuz A, Zimmerli W. Diagnosis and treatment of implant-associated septic arthritis and osteomyelitis. Curr Infect Dis Rep 2008; 10: 394-403
• 65 Hoiby N, Bjarnsholt T, Moser C. et al. ESCMID guideline for the diagnosis and treatment of biofilm infections 2014. Clin Microbiol Infect 2015; 21 (Suppl. 01) S1-S25
• 66 Renz N, Perka C, Trampuz A. Management periprothetischer Infektionen des Kniegelenks. Orthopäde 2016; 45: 65-71
• 67 Zimmerli W. Orthopädische implantatassoziierte Infektionen. Orthopäde 2015; 44: 961-966
• 68 Rosenthall L, Lepanto L, Raymond F. Radiophosphate uptake in asymptomatic knee arthroplasty. J Nucl Med 1987; 28: 1546-1549
• 69 Parvizi J, Gehrke T. International Consensus Group on Periprosthetic Joint Infection. Definition of periprosthetic joint infection. J Arthroplasty 2014; 29: 1331
• 70 Barrack RL, Harris WH. The value of aspiration of the hip joint before revision total hip arthroplasty. J Bone Joint Surg Am 1993; 75: 66-76
• 71 Deirmengian C, Kardos K, Kilmartin P. et al. Combined measurement of synovial fluid α-defensin and C-reactive protein levels: highly accurate for diagnosing periprosthetic joint infection. J Bone Joint Surg Am 2014; 96: 1439-1445
• 72 Okroj KT, Calkins TE, Kayupov E. et al. The alpha-defensin test for diagnosing periprosthetic joint infection in the setting of an adverse local tissue reaction secondary to a failed metal-on-metal bearing or corrosion at the head-neck junction. J Arthroplasty 2018; 33: 1896-1898
• 73 Li C, Renz N, Trampuz A. Management of periprosthetic joint infection. Hip Pelvis 2018; 30: 138-146
• 74 Krenn V, Morawietz L, Kienapfel H. et al. Revised consensus classification. Z Rheumatol 2013; 72: 383-392
• 75 Fink B, Makowiak C, Fuerst M. et al. The value of synovial biopsy, joint aspiration and C-reactive protein in the diagnosis of late peri-prosthetic infection of total knee replacement. J Bone Joint Surg Br 2008; 90: 874-878
• 76 Trampuz A, Piper KE, Jacobson MJ. et al. Sonication of removed hip and knee prostheses for diagnosis of infection. N Engl J Med 2007; 357: 654-663
• 77 Frommelt L. Gelenkpunktat und Erregernachweis bei periprothetischer Infektion. Orthopäde 2008; 37: 1027-1034
• 78 Kriegsmann J, Hopf T, Jacobs D. et al. Molekularpathogenetische Diagnostik von Gelenkinfektionen. Orthopäde 2009; 36: 531-538
• 79 Mikhael MM, Hanssen AD, Sierra RJ. Failure of metal-on-metal total hip arthroplasty mimicking hip infection. A report of two cases. J Bone Joint Surg Am 2009; 91: 443-446
• 80 Bonnaig NS, Freiberg RA, Freiberg AA. Total hip arthroplasty with ceramic-on-ceramic bearing failure from third-body wear. Orthopedics 2011; 34: 132