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Endoprotheseninfektionen der Schulter

Diagnose und Therapiealgorithmus

Endoprosthesis infections of the shoulder

Diagnosis and therapy algorithm

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Zusammenfassung

Die infizierte Schulterprothese erweist sich meist als komplexe Situation, deren aufwendigen Therapieoptionen sich der orthopädische Chirurg zu stellen hat. Einer bestätigten Infektion folgt in der Regel eine operative Maßnahme. Die Behandlungsstrategien orientieren sich an der Kausalität der Infektion, dem zeitlichen Verlauf postoperativer Infektzeichen, der Pathogenität der isolierten Erreger und den Begleiterkrankungen des Patienten. Während eine arthroskopische Spülung und ein offenes Débridement mit Komponentenwechsel in einer akuten Situation sinnvoll sein können, muss bei chronischen Infekten meist zweizeitig unter Einsatz einer antibiotikabeladenen, artikulierenden Interimsprothese vorgegangen werden. Die rechtzeitige Erkennung einer Protheseninfektion ist essenziell, da eine rasche Ausbreitung mit Sepsis und möglicherweise letalem Ausgang die Folge sein kann. So genannte Low-grade-Infekte stellen eine besondere Herausforderung an Diagnose und Therapie. Dieser Artikel fasst die Klassifikation und auch aktuelle Methoden zur Erkennung und Behandlung einer Schulterprotheseninfektion zusammen.

Abstract

Periprosthetic shoulder joint infections are encountered by orthopedic surgeons mainly as complex situations which are highlighted by difficult treatment modalities. In a confirmed infection the general therapeutic principle is a surgical procedure. Several strategies orientate on the cause of an infection, the time course of postoperative symptoms, the pathogenicity of the isolated species and the specific comorbidities of the patient. An arthroscopic joint lavage with open debridement and component change may suffice in selected acute cases whereas a two-stage revision augmented by an articulating antibiotic spacer is mandatory in chronic infections. Early recognition is of paramount importance in order to prevent further spread, sepsis or even fatal outcome. Low grade infections are challenging conditions in terms of diagnosis and treatment. This article summarizes the principles of current classification, detection and treatment strategies for periprosthetic shoulder joint infections.

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  1. Abteilung für Schulterchirurgie, RHÖN Klinikum AG, Salzburger Leite 1, 97616, Bad Neustadt, Deutschland

    R. Hudek & F. Gohlke

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  2. F. Gohlke
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Correspondence to R. Hudek.

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Hudek, R., Gohlke, F. Endoprotheseninfektionen der Schulter. Orthopäde 42, 552–560 (2013). https://doi.org/10.1007/s00132-012-2026-4

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