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Die früh infizierte Duokopfprothese

Ein Behandlungsalgorithmus

Early-onset infection after hemiarthroplasty of the hip

An algorithm for surgical therapy

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Zusammenfassung

Hintergrund

In einer retrospektiven Studie mit 30 Patienten wurden die Ergebnisse unterschiedlicher chirurgischer Therapien eines Frühinfekts nach Implantation einer Duokopfprothese miteinander verglichen.

Material und Methode

Die Patienten wurden in 2 Gruppen eingeteilt: In Gruppe 1 (tiefer Infekt; n=16) wurde sowohl das Polyethylen- (PE-)Inlay des Duokopfes als auch der Kopf ausgewechselt bzw. gegen einen Stahlkopf ersetzt. In Gruppe 2 (tiefer Infekt, n=14) wurde zusätzlich in gleicher Sitzung eine Pfanne implantiert. Alle Patienten wurden postoperativ entsprechend des Keimspektrums antibiotisch behandelt.

Ergebnisse

Der Hauptkeim war in beiden Gruppen Staphylococcus aureus (Gruppe 1: 68%, Gruppe 2: 78%). In Gruppe 1 konnte 6 Monate postoperativ bei 37,5% der Patienten Infektfreiheit erzielt werden, in Gruppe 2 bei 71,4% (p=0,019). Drei Patienten aus Gruppe 1 verstarben im septischen Multiorganversagen. Zwei Patienten aus der Gruppe 1 und ein Patient aus der Gruppe 2 erhielten eine Girdlestone-Operation.

Schlussfolgerung

Die Ergebnisse zeigen, dass beim Vorliegen eines tiefen Frühinfekts ein radikales Débridement mit Kopfwechsel und Implantation einer Pfanne sowie antibiotischer Behandlung die besten Ergebnisse in Bezug auf Infektfreiheit bringt.

Abstract

Background

In a retrospective study, we compared the results of different surgical therapies in 30 patients who had an early-onset infection after implantation of a hip hemiarthroplasty.

Material and methods

Patients were divided into two groups: In group 1 (n=16, deep infection), we changed the polyethylene inlay as well as the femoral head. In group 2 (n=14, deep infection), an acetabular component was also implanted.

Results

In group 1, successful treatment was achieved in 37.5% of patients 6 months after the last operation, compared with 71.4% in group 2 (p=0.019). All patients were supported with antibiotics. In group 1, three patients died from septic multiorgan failure. Two patients in group 1 and one patient in group 2 received a Girdlestone operation.

Conclusions

These results suggest that aggressive surgical treatment with soft tissue revision, lavage, and implantation of an acetabular component in combination with antibiotics is a useful technique for treating early-onset infection.

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Authors and Affiliations

  1. Abteilung für Chirurgie, Standort Eggenfelden, Rottal-Inn-Krankenhäuser, Simonsöder Allee 20, 84307, Eggenfelden, Deutschland

    M. Wick

  2. BG-Klinik Bergmannsheil, Chirurgische Klinik und Poliklinik, Bochum, Deutschland

    I. Maul & G. Muhr

Authors
  1. M. Wick
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  2. I. Maul
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  3. G. Muhr
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Correspondence to M. Wick.

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Wick, M., Maul, I. & Muhr, G. Die früh infizierte Duokopfprothese. Orthopäde 38, 600–605 (2009). https://doi.org/10.1007/s00132-009-1439-1

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  • DOI: https://doi.org/10.1007/s00132-009-1439-1

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