Skip to main content
SpringerLink
Log in

Wechsel infizierter Knie- und Hüftendoprothesen

Replacement of infected knee and hip endoprostheses

  • Leitthema
  • Published:
Der Chirurg Aims and scope Submit manuscript

Zusammenfassung

Infektionen nach Implantation einer Endoprothese treten in 0,5–5% der Fälle auf und stellen eine der schwerwiegendsten Komplikationen nach künstlichem Gelenkersatz dar. Bei ca. 300.000 Primärimplantationen für Hüft- und Kniegelenkendoprothesen im Jahr in Deutschland steigt auch die Zahl früher und später Infektionen, sodass mit ca. 4000 bis 6000 Fällen pro Jahr gerechnet werden muss.

Die periprothetische Infektion bedeutet in aller Regel einen signifikanten Verlust der Funktion und Lebensqualität für den Patienten. Die aufwendige Sanierung verursacht hohe Kosten. Wesentliche Bedeutung haben somit präventive Maßnahmen wie die perioperative Antibiotikaprophylaxe, die Sicherstellung hochsteriler Operationsbedingungen und eine sinnvolle Selektion der Patienten.

Die Identifikation des Erregers, die lokale Eradikation des Infekts meist unter Entfernung der Endoprothese, die testgerechte systemische und lokale Antibiotikatherapie und letztendlich bei infektfreier Situation die Reimplantation einer Revisionsendoprothetik stellen die Grundprinzipien einer adäquaten Wiederherstellung dar. Standard für die Revisionschirurgie ist der zweizeitige Wechsel mit Einhaltung eines infektfreien Intervalls vor der erneuten Endoprothetik. Die ein- oder mehrzeitige Verfahrensstrategie, wie auch die Wahl zementierter oder zementfreier Revision, wird bei noch ausstehender eindeutiger Evaluation zentrentypisch durchgeführt.

Als wesentliche Erfolgsparameter in der Behandlung periprothetischer Infektionen wurden bisher eine möglichst frühzeitige Diagnostik, die radikale chirurgische Sanierung und eine suffiziente Antibiotikatherapie identifiziert und erfolgreiche Sanierungen in ca. 80% der Fälle berichtet. Aufgrund des komplexen Therapieansatzes wird auch unter dem Gesichtspunkt einer anspruchsvollen Patientenführung allgemein die Behandlung in spezialisierten Zentren empfohlen.

Abstract

Infections occur in 0.5–5% of cases after implantation of an endoprosthesis and represent one of the most severe complications of artificial joint replacements. Approximately 300,000 primary implantations for hip and knee prostheses are carried out in Germany annually with a corresponding number of early and late infections. This means that approximately 4,000–6,000 cases are to be expected annually.

Periprosthetic infections normally lead to a significant loss of function and quality of life for patients and the complex remediation is costly. Therefore, preventive measures, such as perioperative prophylaxis with antibiotics, maintaining highly sterile conditions during operations and an expedient selection of patients are of substantial importance.

The basic principles of an adequate restoration include identification of the pathogen, local eradication of the infection mostly after removal of the prosthesis, pathogen-oriented systemic and local antibiotic therapy and finally re-implantation of the revision prosthesis under infection-free conditions. The standard procedure for revision surgery is a two-phase replacement with maintenance of an infection-free interval before renewal of the prosthesis. The use of single-phase or multi-phase strategies, as well as the selection of cemented or cement-free revision, varies between centers as a definitive evaluation is not yet available.

The most important parameters for successful treatment of periprosthetic infections have been identified as the earliest possible diagnosis, radical surgical cleansing with an adequate antibiotic therapy and successful restoration has been reported in approximately 80% of cases. Because of the complex therapy regime, treatment in specialized centers is generally recommended especially under the aspect of a demanding patient monitoring.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4
Abb. 5
Abb. 6
Abb. 7
Abb. 8

Literatur

  1. Ahlberg A, Carlsson AS, Lindberg L (1978) Hematogenous infection in total joint replacement. Clin Orthop Relat Res 69–75

  2. Al LN, Rohde H, Sander G et al (2007) Augmented expression of polysaccharide intercellular adhesin in a defined Staphylococcus epidermidis mutant with the small-colony-variant phenotype. J Bacteriol 189:4494–4501

    Article  Google Scholar 

  3. Anagnostakos K, Kelm J, Schmitt E (2006) Indications for use of the V.A.C.-system in the orthopedic surgery. Zentralbl Chir 131 [Suppl 1]:87–92

    Google Scholar 

  4. Anagnostakos K, Wilmes P, Schmitt E, Kelm J (2009) Elution of gentamicin and vancomycin from polymethylmethacrylate beads and hip spacers in vivo. Acta Orthop 80:193–197

    Article  PubMed  Google Scholar 

  5. Andollina A, Bertoni G, Zolezzi C et al (2008) Vancomycin and meropenem in acrylic cement: elution kinetics of in vitro bactericidal action. Chir Organi Mov 91:153–158

    Article  PubMed  Google Scholar 

  6. Antoci V, Phillips MJ, Antoci V Jr, Krackow KA (2009) Using an antibiotic-impregnated cement rod-spacer in the treatment of infected total knee arthroplasty. Am J Orthop 38:31–33

    Article  PubMed  Google Scholar 

  7. Bauer TW, Parvizi J, Kobayashi N, Krebs V (2006) Diagnosis of periprosthetic infection. J Bone Joint Surg Am 88:869–882

    Article  PubMed  Google Scholar 

  8. Berbari EF, Hanssen AD, Duffy MC et al (1998) Risk factors for prosthetic joint infection: case-control study. Clin Infect Dis 27:1247–1254

    Article  CAS  PubMed  Google Scholar 

  9. Berbari EF, Marculescu C, Sia I et al (2007) Culture-negative prosthetic joint infection. Clin Infect Dis 45:1113–1119

    Article  PubMed  Google Scholar 

  10. Berbari EF, Osmon DR, Duffy MC et al (2006) Outcome of prosthetic joint infection in patients with rheumatoid arthritis: the impact of medical and surgical therapy in 200 episodes. Clin Infect Dis 42:216–223

    Article  PubMed  Google Scholar 

  11. Biring GS, Kostamo T, Garbuz DS et al (2009) Two-stage revision arthroplasty of the hip for infection using an interim articulated Prostalac hip spacer: a 10- to 15-year follow-up study. J Bone Joint Surg Br 91:1431–1437

    Article  CAS  PubMed  Google Scholar 

  12. Birkenhauer B, Kistmacher H, Ries J (2004) Conception and first results of the spiron cementless femoral neck screw prosthesis. Orthopade 33:1259–1266

    Article  CAS  PubMed  Google Scholar 

  13. Bryers JD, Ratner BD (2006) Biomaterials approaches to combating oral biofilms and dental disease. BMC Oral Health 6 [Suppl 1]:15

  14. Cadambi A, Jones RE, Maale GE (1995) A new technique for staged revision of infected total joint arthroplasties: The use of antibiotic-cement-implant composite spacers. Orthopedics Intern Edn 3(2)

  15. Costerton JW, Geesey GG, Cheng KJ (1978) How bacteria stick. Sci Am 238:86–95

    Article  CAS  PubMed  Google Scholar 

  16. Cramer J, Ekkernkamp A, Ostermann PA (2001) The infected endoprosthesis with the example of the hip joint endoprosthesis. An increasing danger to patient and society. Z Arztl Fortbild Qualitatssich 95:195–201

    CAS  PubMed  Google Scholar 

  17. Crockarell JR, Hanssen AD, Osmon DR, Morrey BF (1998) Treatment of infection with debridement and retention of the components following hip arthroplasty. J Bone Joint Surg Am 80:1306–1313

    CAS  PubMed  Google Scholar 

  18. Cuckler JM, Star AM, Alavi A, Noto RB (1991) Diagnosis and management of the infected total joint arthroplasty. Orthop Clin North Am 22:523–530

    CAS  PubMed  Google Scholar 

  19. Dairaku K, Takagi M, Kawaji H et al (2009) Antibiotics-impregnated cement spacers in the first step of two-stage revision for infected totally replaced hip joints: report of ten trial cases. J Orthop Sci 14:704–710

    Article  PubMed  Google Scholar 

  20. Disch AC, Matziolis G, Perka C (2007) Two-stage operative strategy without local antibiotic treatment for infected hip arthroplasty: clinical and radiological outcome. Arch Orthop Trauma Surg 127:691–697

    Article  PubMed  Google Scholar 

  21. Dovas S, Liakopoulos V, Papatheodorou L et al (2008) Acute renal failure after antibiotic-impregnated bone cement treatment of an infected total knee arthroplasty. Clin Nephrol 69:207–212

    CAS  PubMed  Google Scholar 

  22. Durbhakula SM, Czajka J, Fuchs MD, Uhl RL (2004) Antibiotic-loaded articulating cement spacer in the 2-stage exchange of infected total knee arthroplasty. J Arthroplasty 19:768–774

    Article  PubMed  Google Scholar 

  23. Durbhakula SM, Czajka J, Fuchs MD, Uhl RL (2004) Spacer endoprosthesis for the treatment of infected total hip arthroplasty. J Arthroplasty 19:760–767

    Article  PubMed  Google Scholar 

  24. Eiff C von, Bettin D, Proctor RRB et al (1997) Recovery of small colony variants of staphylococcus aureus following gentamicin bead placement for osteomyelitis. Clin Infect Dis 25:1251

    Article  Google Scholar 

  25. Evans RP (2004) Successful treatment of total hip and knee infection with articulating antibiotic components: a modified treatment method. Clin Orthop Relat Res 37–46

  26. Fink B, Makowiak C, Fuerst M et al (2008) The value of synovial biopsy, joint aspiration and C-reactive protein in the diagnosis of late peri-prosthetic infection of total knee replacements. J Bone Joint Surg Br 90-B:874–878

    Google Scholar 

  27. Fitzgerald RH Jr, Nolan DR, Ilstrup DM et al (1977) Deep wound sepsis following total hip arthroplasty. J Bone Joint Surg Am 59:847–855

    PubMed  Google Scholar 

  28. Friesecke C, Wodtke J (2006) Periprosthetic knee infection. One-stage exchange. Orthopade 35:937–1005

    Article  CAS  PubMed  Google Scholar 

  29. Friesecke C, Wodtke J (2008) Management of periprosthetic infection. Chirurg 79:777–792

    Article  CAS  PubMed  Google Scholar 

  30. Frommelt L (2004) Guidelines on antimicrobial therapy in situations of periprosthetic THR infection. Orthopade 33:822–828

    Article  CAS  PubMed  Google Scholar 

  31. Frommelt L (2009) Diagnosis and treatment of foreign-body-associated infection in orthopaedic surgery. Orthopade

  32. Geipel U (2009) Pathogenic organisms in hip joint infections. Int J Med Sci 6:234–240

    CAS  PubMed  Google Scholar 

  33. Geipel U, Herrmann M (2005) The infected implant: bacteriology. Unfallchirurg 108:961–975

    Article  CAS  PubMed  Google Scholar 

  34. Ghanem E, Ketonis C, Restrepo C et al (2009) Periprosthetic infection: where do we stand with regard to Gram stain? Acta Orthop 80:37–40

    Article  PubMed  Google Scholar 

  35. Gollwitzer H, Diehl P, Gerdesmeyer L, Mittelmeier W (2006) Diagnostic strategies in cases of suspected periprosthetic infection of the knee. A review of the literature and current recommendations. Orthopade 35:904, 906

    Article  CAS  PubMed  Google Scholar 

  36. Gorenoi V, Schönermark MP, Hagen A (2009) Gelenkendoprothesenregister für Deutschland. Schriftenreihe Health Technonoly Assessment. DIMDI, Köln, Ref Type: Report

  37. Haaker R, Senge A, Kramer J, Rubenthaler F (2004) Osteomyelitis after endoprostheses. Orthopade 33:431–438

    Article  CAS  PubMed  Google Scholar 

  38. Haddad FS, Muirhead-Allwood SK, Manktelow AR, Bacarese-Hamilton I (2000) Two-stage uncemented revision hip arthroplasty for infection. J Bone Joint Surg Br 82:689–694

    Article  CAS  PubMed  Google Scholar 

  39. Hanssen AD, Rand JA (1999) Evaluation and treatment of infection at the site of a total hip or knee arthroplasty. Instr Course Lect 48:111–122

    CAS  PubMed  Google Scholar 

  40. Hart WJ, Jones RS (2006) Two-stage revision of infected total knee replacements using articulating cement spacers and short-term antibiotic therapy. J Bone Joint Surg Br 88:1011–1015

    Article  CAS  PubMed  Google Scholar 

  41. Hope PG, Kristinsson KG, Norman P, Elson RA (1989) Deep infection of cemented total hip arthroplasties caused by coagulase-negative staphylococci. J Bone Joint Surg Br 71-B:851–855

    Google Scholar 

  42. Hsieh PH, Chang YH, Chen SH et al (2006) High concentration and bioactivity of vancomycin and aztreonam eluted from Simplex cement spacers in two-stage revision of infected hip implants: a study of 46 patients at an average follow-up of 107 days. J Orthop Res 24:1615–1621

    Article  CAS  PubMed  Google Scholar 

  43. Hsieh PH, Huang KC, Lee PC, Lee MS (2009) Two-stage revision of infected hip arthroplasty using an antibiotic-loaded spacer: retrospective comparison between short-term and prolonged antibiotic therapy. J Antimicrob Chemother 64:392–397

    Article  CAS  PubMed  Google Scholar 

  44. Hsieh PH, Shih CH, Chang YH et al (2005) Treatment of deep infection of the hip associated with massive bone loss: two-stage revision with an antibiotic-loaded interim cement prosthesis followed by reconstruction with allograft. J Bone Joint Surg Br 87:770–775

    Article  PubMed  Google Scholar 

  45. Hsu CS, Hsu CC, Wang JW, Lin PC (2008) Two-stage revision of infected total knee arthroplasty using an antibiotic-impregnated static cement-spacer. Chang Gung Med J 31:583–591

    PubMed  Google Scholar 

  46. Husted H, Jensen T (2002) Clinical outcome after treatment of infected primary total knee arthroplasty. Acta Orthop Belg 68:500–507

    CAS  PubMed  Google Scholar 

  47. Ince A, Rupp J, Frommelt L et al (2004) Is „aseptic“ loosening of the prosthetic cup after total hip replacement due to nonculturable bacterial pathogens in patients with low-grade infection? Clin Infect Dis 39:1599–1603

    Article  CAS  PubMed  Google Scholar 

  48. Ip D, Yam SK, Chen CK (2005) Implications of the changing pattern of bacterial infections following total joint replacements. J Orthop Surg (Hong Kong) 13:125–130

    Google Scholar 

  49. Jamsen E, Sheng P, Halonen P et al (2006) Spacer prostheses in two-stage revision of infected knee arthroplasty. Int Orthop 30:257–261

    Article  CAS  PubMed  Google Scholar 

  50. Jamsen E, Stogiannidis I, Malmivaara A et al (2009) Outcome of prosthesis exchange for infected knee arthroplasty: the effect of treatment approach. Acta Orthop 80:67–77

    Article  PubMed  Google Scholar 

  51. Jeys L, Grimer R (2009) The long-term risks of infection and amputation with limb salvage surgery using endoprostheses. Recent Results Cancer Res 179:75–84

    Article  PubMed  Google Scholar 

  52. Jiranek WA, Hanssen AD, Greenwald AS (2006) Antibiotic-loaded bone cement for infection prophylaxis in total joint replacement. J Bone Joint Surg Am 88:2487–2500

    Article  PubMed  Google Scholar 

  53. Kahl BC, Belling G, Reichelt R et al (2003) Thymidine-dependent small-colony variants of staphylococcus aureus exhibit gross morphological and ultrastructural changes consistent with impaired cell separation. J Clin Microbiol 41:410–413

    Article  PubMed  Google Scholar 

  54. Kelm J, Anagnostakos K, Schmitt E (2004) Closed subfascial V.A.C.-therapy in periprosthetic hip infections. Zentralbl Chir 129 [Suppl 1]:49–52

    Google Scholar 

  55. Kelm J, Schmitt E, Anagnostakos K (2009) Vacuum-assisted closure in the treatment of early hip joint infections. Int J Med Sci 6:241–246

    CAS  PubMed  Google Scholar 

  56. Kordelle J, Frommelt L, Kluber D, Seemann K (2000) Results of one-stage endoprosthesis revision in periprosthetic infection cause by methicillin-resistant staphylococcus aureus. Z Orthop Ihre Grenzgeb 138:240–244

    Article  CAS  PubMed  Google Scholar 

  57. Krenn V, Otto M, Morawietz L et al (2009) Histopathologic diagnostics in endoprosthetics: periprosthetic neosynovialitis, hypersensitivity reaction and arthrofibrosis. Orthopade 38:520–530

    Article  CAS  PubMed  Google Scholar 

  58. Lehner B, Bernd L (2006) V.A.C.-instill therapy in periprosthetic infection of hip and knee arthroplasty. Zentralbl Chir 131 [Suppl 1]:160–164

    Google Scholar 

  59. Lehner B, Suda A, Zeifang F (2007) Ergebnisse der V.A.C.-Instill-Therapie bei Infekten von Knie- und Hüftendoprothesen. In: Foederatio Medicorum Chirurgicorum Helvetica (Hrsg) V.A.C.Therapy – Better woundcare by any definition. Luzern, S 44–48

  60. Lehner B, Witte D, Suda A, Weiss S (2009) Revision strategy for periprosthetic infection. Orthopade 38:681–688

    Article  CAS  PubMed  Google Scholar 

  61. Leone JM, Hanssen AD (2006) Management of infection at the site of a total knee arthroplasty. Instr Course Lect 55:449–461

    PubMed  Google Scholar 

  62. Lortat-Jacob A (1994) Antibiotic prophylaxis in orthopedic surgery. Ann Fr Anesth Reanim 13:51–60

    Google Scholar 

  63. Mariani BD, Tuan RS (1998) Advances in the diagnosis of infection in prosthetic joint implants. Mol Med Today 4:207–213

    Article  CAS  PubMed  Google Scholar 

  64. Mason JB, Fehring TK, Odum SM et al (2003) The value of white blood cell counts before revision total knee arthroplasty. J Arthroplasty 18:1038–1043

    Article  PubMed  Google Scholar 

  65. Masri BA, Duncan CP, Beauchamp CP (1998) Long-term elution of antibiotics from bone-cement: an in vivo study using the prosthesis of antibiotic-loaded acrylic cement (PROSTALAC) system. J Arthroplasty 13:331–338

    Article  CAS  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  67. Mehta S, Humphrey JS, Schenkman DI et al (1996) Gentamicin distribution from a collagen carrier. J Orthop Res 14:749–754

    Article  CAS  PubMed  Google Scholar 

  68. Mihalko WM, Manaswi A, Cui Q et al (2008) Diagnosis and treatment of the infected primary total knee arthroplasty. Instr Course Lect 57:327–339

    PubMed  Google Scholar 

  69. Mitchell PA, Masri BA, Garbuz DS et al (2003) Cementless revision for infection following total hip arthroplasty. Instr Course Lect 52:323–330

    PubMed  Google Scholar 

  70. Mittal Y, Fehring TK, Hanssen A et al (2007) Two-stage reimplantation for periprosthetic knee infection involving resistant organisms. J Bone Joint Surg Am 89:1227–1231

    Article  PubMed  Google Scholar 

  71. Mohanty SS, Kay PR (2004) Infection in total joint replacements. Why we screen MRSA when MRSE is the problem? J Bone Joint Surg Br 86:266–268

    Article  CAS  PubMed  Google Scholar 

  72. Mooij MJ, Drenkard E, Llamas MA et al (2007) Characterization of the integrated filamentous phage Pf5 and its involvement in small-colony formation. Microbiology 153:1790–1798

    Article  CAS  PubMed  Google Scholar 

  73. Morawietz L, Classen RA, Schroder JH et al (2006) Proposal for a histopathological consensus classification of the periprosthetic interface membrane. J Clin Pathol 59:591–597

    Article  CAS  PubMed  Google Scholar 

  74. Moyad TF, Thornhill T, Estok D (2008) Evaluation and management of the infected total hip and knee. Orthopedics 31:581–588

    Article  PubMed  Google Scholar 

  75. Munjal S, Phillips MJ, Krackow KA (2001) Revision total knee arthroplasty: planning, controversies and management – infection. Instr Course Lect 50:367–377

    CAS  PubMed  Google Scholar 

  76. Neut D, van H Jr, Kooten TG van et al (2003) Detection of biomaterial-associated infections in orthopaedic joint implants. Clin Orthop Relat Res 261–268

  77. Phillips JE, Crane TP, Noy M et al (2006) The incidence of deep prosthetic infections in a specialist orthopaedic hospital: A 15-year prospective survey. J Bone Joint Surg Br 88-B:943–948

    Google Scholar 

  78. Pietsch M, Hofmann S, Wenisch C (2006) Treatment of deep infection of total knee arthroplasty using a two-stage procedure. Oper Orthop Traumatol 18:66–87

    Article  PubMed  Google Scholar 

  79. Pietsch M, Wenisch C, Traussnig S et al (2003) Temporary articulating spacer with antibiotic-impregnated cement for an infected knee endoprosthesis. Orthopade 32:490–497

    CAS  PubMed  Google Scholar 

  80. Powers KA, Terpenning MS, Voice RA, Kauffman CA (1990) Prosthetic joint infections in the elderly. Am J Med 88:9N–13N

    CAS  PubMed  Google Scholar 

  81. Proctor RA, Peters G (1998) Small colony variants in staphylococcal infections: diagnostic and therapeutic implications. Clin Infect Dis 27:419–422

    Article  CAS  PubMed  Google Scholar 

  82. Proctor RA, von EC, Kahl BC et al (2006) Small colony variants: a pathogenic form of bacteria that facilitates persistent and recurrent infections. Nat Rev Microbiol 4:295–305

    Article  CAS  PubMed  Google Scholar 

  83. Ramage G, Tunney MM, Patrick S et al (2003) Formation of propionibacterium acnes biofilms on orthopaedic biomaterials and their susceptibility to antimicrobials. Biomaterials 24:3221–3227

    Article  CAS  PubMed  Google Scholar 

  84. Raut VV, Siney PD, Wroblewski BM (1995) One-stage revision of total hip arthroplasty for deep infection. Long-term follow up. Clin Orthop Relat Res 202–207

  85. Ruchholtz S, Täger G, Nast-Kolb D (2004) Die infizierte Hüftgelenksendoprothese. Unfallchirurg 4:307–319

    Article  Google Scholar 

  86. Schafer P, Fink B, Sandow D et al (2008) Prolonged bacterial culture to identify late periprosthetic joint infection: a promising strategy. Clin Infect Dis 47:1403–1409

    Article  PubMed  Google Scholar 

  87. Schierholz JM, Morsczeck C, Brenner N et al (2004) Special aspects of implant-associated infection in orthopedic surgery. From the pathophysiology to custom-tailored prevention strategies. Orthopade 33:397–404

    Article  CAS  PubMed  Google Scholar 

  88. Seldes RM, Winiarsky R, Jordan LC et al (2005) Liquid gentamicin in bone cement: a laboratory study of a potentially more cost-effective cement spacer. J Bone Joint Surg Am 87:268–272

    Article  PubMed  Google Scholar 

  89. Shiramizu K, Lovric V, Leung A, Walsh WR (2008) How do porosity-inducing techniques affect antibiotic elution from bone cement? An in vitro comparison between hydrogen peroxide and a mechanical mixer. J Orthop Traumatol 9:17–22

    Article  CAS  PubMed  Google Scholar 

  90. Simmons TD, Stern SH (1996) Diagnosis and management of the infected total knee arthroplasty. Am J Knee Surg 9:99–106

    CAS  PubMed  Google Scholar 

  91. Souillac V, Costes S, Aunoble S et al (2006) Evaluation of an articulated spacer for two-stage reimplantation for infected total knee arthroplasty: 28 cases. Rev Chir Orthop Reparatrice Appar Mot 92:485–489

    CAS  PubMed  Google Scholar 

  92. Srivastav AK, Nadkarni B, Srivastav S et al (2009) Prophylactic use of antibiotic-loaded bone cement in primary total knee arthroplasty: Justified or not? Indian J Orthop 43:259–263

    Article  PubMed  Google Scholar 

  93. Steinbrink K, Frommelt L (1995) Treatment of periprosthetic infection of the hip using one-stage exchange surgery. Orthopade 24:335–343

    CAS  PubMed  Google Scholar 

  94. Stevens CM, Tetsworth KD, Calhoun JH, Mader JT (2005) An articulated antibiotic spacer used for infected total knee arthroplasty: a comparative in vitro elution study of simplex and palacos bone cements. J Orthop Res 23:27–33

    Article  CAS  PubMed  Google Scholar 

  95. Sudo A, Hasegawa M, Fukuda A, Uchida A (2008) Treatment of infected hip arthroplasty with antibiotic-impregnated calcium hydroxyapatite. J Arthroplasty 23:145–150

    Article  PubMed  Google Scholar 

  96. Takigami I, Ito Y, Ishimaru D et al (2009) Two-stage revision surgery for hip prosthesis infection using antibiotic-loaded porous hydroxyapatite blocks. Arch Orthop Trauma Surg

  97. Thabe H, Schill S (2007) Two-stage reimplantation with an application spacer and combined with delivery of antibiotics in the management of prosthetic joint infection. Oper Orthop Traumatol 19:78–100

    Article  PubMed  Google Scholar 

  98. Toms AD, Davidson D, Masri BA, Duncan CP (2006) The management of peri-prosthetic infection in total joint arthroplasty. J Bone Joint Surg Br 88-B:149–155

    Google Scholar 

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

  100. Tsukayama DT, Estrada R, Gustilo RB (1996) Infection after total hip arthroplasty. A study of the treatment of one hundred and six infections. J Bone Joint Surg Am 78:512–523

    CAS  PubMed  Google Scholar 

  101. Villanueva-Martinez M, Rios-Luna A, Pereiro J et al (2008) Hand-made articulating spacers in two-stage revision for infected total knee arthroplasty: good outcome in 30 patients. Acta Orthop 79:674–682

    Article  PubMed  Google Scholar 

  102. von Eiff C, McNamara P, Becker K et al (2006) Phenotype microarray profiling of Staphylococcus aureus menD and hemB mutants with the small-colony-variant phenotype. J Bacteriol 188:687–693

    Article  Google Scholar 

  103. von Eiff C, Proctor RA, Peters G (2000) Small colony variants of Staphylococci: a link to persistent infections. Berl Munch Tierarztl Wochenschr 113:321–325

    Google Scholar 

  104. von Eiff C, Proctor RA, Peters G (2000) Staphylococcus aureus small colony variants: formation and clinical impact. Int J Clin Pract [Suppl]: 44–49

  105. von Eiff C, Vaudaux P, Kahl BC et al (1999) Bloodstream infections caused by small-colony variants of coagulase-negative staphylococci following pacemaker implantation. Clin Infect Dis 29:932–934

    Article  Google Scholar 

  106. Wagner C, Hansch GM, Wentzensen A, Heppert V (2006) Implant-associated post-traumatic osteomyelitis. Bacterial biofilms and the immune defence as protagonists of the local inflammatory process. Unfallchirurg 109:761–769

    Article  CAS  PubMed  Google Scholar 

  107. Wagner C, Zimmermann S, Brenner-Weiss G et al (2007) The quorum-sensing molecule N-3-oxododecanoyl homoserine lactone (3OC12-HSL) enhances the host defence by activating human polymorphonuclear neutrophils (PMN). Anal Bioanal Chem 387:481–487

    Article  CAS  PubMed  Google Scholar 

  108. Whittaker JP, Warren RE, Jones RS, Gregson PA (2009) Is prolonged systemic antibiotic treatment essential in two-stage revision hip replacement for chronic Gram-positive infection? J Bone Joint Surg Br 91:44–51

    CAS  PubMed  Google Scholar 

  109. Wodtke J, Lohr JF (2008) The infected implant. Orthopade 37:257–267

    Article  CAS  PubMed  Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. BG Unfallklinik Murnau, Prof.-Küntscher-Straße 8, 82418, Murnau, Deutschland

    M. Militz & V. Bühren

Authors
  1. M. Militz
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. V. Bühren
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M. Militz.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Militz, M., Bühren, V. Wechsel infizierter Knie- und Hüftendoprothesen. Chirurg 81, 310–320 (2010). https://doi.org/10.1007/s00104-009-1842-5

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00104-009-1842-5

Schlüsselwörter

Keywords

Search

Navigation