Management bei fr�hem Gelenkinfekt

Abstract

Zusammenfassung Ursache von Kniegelenkinfekten sind offene und arthroskopische Eingriffe, intraartikuläre Injektionen sowie hämatogene Infekte. Bei der Behandlung von Kniegelenkinfekten kommen offene Methoden wie die Wundrevision mit oder ohne Synovektomie, Spül-Saug-Drainage-Verfahren in offenen und geschlossenen Systemen sowie die Applikation von Antibiotikaketten zum Einsatz. In den letzten Jahren hat sich die Arthroskopie als Standardverfahren etabliert. In der 1. Sitzung wird stadiengerecht therapiert. Im Stadium I erfolgt lediglich eine Spülung, bei fortgeschrittenem Stadium II und im Stadium III eine zusätzliche Synovektomie. Im Stadium IV verbietet sich ein rein arthroskopisches Verfahren, hier ist die offene Chirurgie angebracht. Bei arthroskopisch nicht beherrschbaren Infekten kommen offene Techniken zum Einsatz. Im Rahmen einer retrospektiven Studie wurden 67 von 117 Patienten nach durchschnittlich 2 1/2 Jahren nachuntersucht. Abstract Knee infections can be caused by intra-articular injections and haematogenous infections, as well as by open and arthroscopical operative treatments of the knee. The most frequent cause is puncture, followed by postoperative infection. In approximately one third of our patients no bacteria were detected by examination of their blood, even though the infection was clearly obvious macroscopically. Various types of treatment are used for these infections: open methods such as revision of the wound with or without synovectomy, suction and irrigation drainage in open and closed procedures, and application of a chain-antibiotic system. In recent years, however, experience of treating these infections has led to adoption of the arthroscopic method as the standard procedure. Because of our positive results with arthroscopy, we ourselves now also use this method according to a standardized scheme. The initial treatment of the knee depends on the stage of infection. In stage I we merely clean the wound by irrigating it, while in stages II and III a synovectomy is also performed. In stage IV joint infection, an arthroscopical treatment is no longer possible and open surgery is indicated. There are other circumstances in which the arthroscopical method is not equal to the infection, regardless of its stage, and open techniques are needed. Any further treatments are linked to the individual patient's recuperation. Follow-up examinations were possible in 67 of our 117 patients after an average of 2 1/2 years.