nach oben

International Orthopaedics

Erschienen in:

Open Access 22.10.2019 | Review

Twenty common errors in the diagnosis and treatment of periprosthetic joint infection

verfasst von: Cheng Li, Nora Renz, Andrej Trampuz, Cristina Ojeda-Thies

Erschienen in: International Orthopaedics | Ausgabe 1/2020

Einloggen, um Zugang zu erhalten

Abstract

Background

Misconceptions and errors in the management of periprosthetic joint infection (PJI) can compromise the treatment success. The goal of this paper is to systematically describe twenty common mistakes in the diagnosis and management of PJI, to help surgeons avoid these pitfalls.

Materials and methods

Common diagnostic and treatment errors are described, analyzed and interpreted.

Results

Diagnostic errors include the use of serum inflammatory biomarkers (such as C-reactive protein) to rule out PJI, incomplete evaluation of joint aspirate, and suboptimal microbiological procedures (such as using swabs or collection of insufficient number of periprosthetic samples). Further errors are missing possible sources of distant infection in hematogenous PJI or overreliance on suboptimal diagnostic criteria which can hinder or delay the diagnosis of PJI or mislabel infections as aseptic failure. Insufficient surgical treatment or inadequate antibiotic treatment are further reasons for treatment failure and emergence of antimicrobial resistance. Finally, wrong surgical indication, both underdebridement and overdebridement or failure to individualize treatment can jeopardize surgical results.

Conclusion

Multidisciplinary teamwork with infectious disease specialists and microbiologists in collaboration with orthopedic surgeons have a synergistic effect on the management of PJI. An awareness of the possible pitfalls can improve diagnosis and treatment results.

Jafari SM, Coyle C, Mortazavi SMJ et al (2010) Revision hip arthroplasty: infection is the most common cause of failure. Clin Orthop Relat Res 468:2046–2051. https://doi.org/10.1007/s11999-010-1251-6 CrossRefPubMedPubMedCentral

Thiele K, Perka C, Matziolis G et al (2015) Current failure mechanisms after knee arthroplasty have changed: polyethylene wear is less common in revision surgery. J Bone Joint Surg Am 97:715–720. https://doi.org/10.2106/JBJS.M.01534 CrossRefPubMed

Parvizi J, Gehrke T, Mont MA, Callaghan JJ (2019) Introduction: proceedings of International Consensus on Orthopedic Infections. J Arthroplast 34:S1–S2. https://doi.org/10.1016/j.arth.2018.09.038 CrossRef

Osmon DR, Berbari EF, Berendt AR et al (2013) Diagnosis and management of prosthetic joint infection: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis 56:e1–e25. https://doi.org/10.1093/cid/cis803 CrossRefPubMed

Arvieux C, Common H (2019) New diagnostic tools for prosthetic joint infection. Orthop Traumatol Surg Res 105:S23–S30. https://doi.org/10.1016/j.otsr.2018.04.029 CrossRefPubMed

Li C, Renz N, Trampuz A (2018) Management of periprosthetic joint infection. Hip Pelvis 30:138–146. https://doi.org/10.5371/hp.2018.30.3.138 CrossRefPubMedPubMedCentral

Li C, Renz N, Thies CO, Trampuz A (2018) Meta-analysis of sonicate fluid in blood culture bottles for diagnosing periprosthetic joint infection. J Bone Jt Infect 3:273–279. https://doi.org/10.7150/jbji.29731 CrossRefPubMedPubMedCentral

Leonard HAC, Liddle AD, Burke O et al (2014) Single- or two-stage revision for infected total hip arthroplasty? A systematic review of the literature. Clin Orthop Relat Res 472:1036–1042. https://doi.org/10.1007/s11999-013-3294-y CrossRefPubMed

Masters JPM, Smith NA, Foguet P et al (2013) A systematic review of the evidence for single stage and two stage revision of infected knee replacement. BMC Musculoskelet Disord 14:222. https://doi.org/10.1186/1471-2474-14-222 CrossRefPubMedPubMedCentral

10.

Nagra NS, Hamilton TW, Ganatra S et al (2016) One-stage versus two-stage exchange arthroplasty for infected total knee arthroplasty: a systematic review. Knee Surg Sports Traumatol Arthrosc 24:3106–3114. https://doi.org/10.1007/s00167-015-3780-8 CrossRefPubMed

11.

Yaghmour KM, Chisari E, Khan WS (2019) Single-stage revision surgery in infected total knee arthroplasty: a PRISMA systematic review. J Clin Med 8. https://doi.org/10.3390/jcm8020174 CrossRef

12.

Kunutsor SK, Whitehouse MR, Lenguerrand E, et al (2016) Re-infection outcomes following one- and two-stage surgical revision of infected knee prosthesis: a systematic review and meta-analysis. PLoS One 11. https://doi.org/10.1371/journal.pone.0151537 CrossRef

13.

Fagotti L, Tatka J, Salles MJC, Queiroz MC (2018) Risk factors and treatment options for failure of a two-stage exchange. Curr Rev Musculoskelet Med 11:420–427. https://doi.org/10.1007/s12178-018-9504-1 CrossRefPubMedPubMedCentral

14.

Borens O, Tissot C, Delaloye J-R, Trampuz A (2012) Ten errors to avoid while dealing with infected total joint arthroplasties. Rev Med Suisse 8:2452–2456PubMed

15.

Kocjančič B, Dolinar D (2014) The most common surgical errors in the treatment of prosthetic joint infections. Zdravniški Vestnik 83:544–554

16.

Tsang S-TJ, Ting J, Simpson AHRW, Gaston P (2017) Outcomes following debridement, antibiotics and implant retention in the management of periprosthetic infections of the hip: a review of cohort studies. Bone Joint J 99-B:1458–1466. https://doi.org/10.1302/0301-620X.99B11.BJJ-2017-0088.R1 CrossRefPubMed

17.

Gbejuade HO, Lovering AM, Webb JC (2015) The role of microbial biofilms in prosthetic joint infections. Acta Orthop 86:147–158. https://doi.org/10.3109/17453674.2014.966290 CrossRefPubMedPubMedCentral

18.

Zimmerli W, Sendi P (2017) Orthopaedic biofilm infections. APMIS 125:353–364. https://doi.org/10.1111/apm.12687 CrossRefPubMed

19.

Aggarwal VK, Higuera C, Deirmengian G et al (2013) Swab cultures are not as effective as tissue cultures for diagnosis of periprosthetic joint infection. Clin Orthop Relat Res 471:3196–3203. https://doi.org/10.1007/s11999-013-2974-y CrossRefPubMedPubMedCentral

20.

Tetreault MW, Wetters NG, Aggarwal VK et al (2013) Should draining wounds and sinuses associated with hip and knee arthroplasties be cultured? J Arthroplast 28:133–136. https://doi.org/10.1016/j.arth.2013.04.057 CrossRef

21.

Ahmad SS, Becker R, Chen AF, Kohl S (2016) EKA survey: diagnosis of prosthetic knee joint infection. Knee Surg Sports Traumatol Arthrosc 24:3050–3055. https://doi.org/10.1007/s00167-016-4303-y CrossRefPubMed

22.

Della Valle C, Parvizi J, Bauer TW et al (2011) American Academy of Orthopaedic Surgeons clinical practice guideline on: the diagnosis of periprosthetic joint infections of the hip and knee. J Bone Joint Surg Am 93:1355–1357. https://doi.org/10.2106/JBJS.9314ebo CrossRefPubMed

23.

Pérez-Prieto D, Portillo ME, Puig-Verdié L et al (2017) C-reactive protein may misdiagnose prosthetic joint infections, particularly chronic and low-grade infections. Int Orthop 41:1315–1319. https://doi.org/10.1007/s00264-017-3430-5 CrossRefPubMed

24.

Akgün D, Müller M, Perka C, Winkler T (2018) The serum level of C-reactive protein alone cannot be used for the diagnosis of prosthetic joint infections, especially in those caused by organisms of low virulence. Bone Joint J 100-B:1482–1486. https://doi.org/10.1302/0301-620X.100B11.BJJ-2018-0514.R1 CrossRefPubMed

25.

Renz N, Mudrovcic S, Perka C, Trampuz A (2018) Orthopedic implant-associated infections caused by Cutibacterium spp.—a remaining diagnostic challenge. PLoS One 13:e0202639. https://doi.org/10.1371/journal.pone.0202639 CrossRefPubMedPubMedCentral

26.

Shahi A, Deirmengian C, Higuera C et al (2015) Premature therapeutic antimicrobial treatments can compromise the diagnosis of late periprosthetic joint infection. Clin Orthop Relat Res 473:2244–2249. https://doi.org/10.1007/s11999-015-4142-z CrossRefPubMedPubMedCentral

27.

Parvizi J, Zmistowski B, Berbari EF et al (2011) New definition for periprosthetic joint infection: from the Workgroup of the Musculoskeletal Infection Society. Clin Orthop Relat Res 469:2992–2994. https://doi.org/10.1007/s11999-011-2102-9 CrossRefPubMedPubMedCentral

28.

Bauer TW, Bedair H, Creech JD et al (2019) Hip and knee section, diagnosis, laboratory tests: proceedings of International Consensus on Orthopedic Infections. J Arthroplast 34:S351–S359. https://doi.org/10.1016/j.arth.2018.09.019 CrossRef

29.

Rakow A, Perka C, Trampuz A, Renz N (2018) Origin and characteristics of haematogenous periprosthetic joint infection. Clin Microbiol Infect. https://doi.org/10.1016/j.cmi.2018.10.010 CrossRef

30.

Fernández-Sampedro M, Fariñas-Alvarez C, Garces-Zarzalejo C, et al (2017) Accuracy of different diagnostic tests for early, delayed and late prosthetic joint infection. BMC Infect Dis 17. https://doi.org/10.1186/s12879-017-2693-1

31.

Karczewski D, Winkler T, Perka C, Müller M (2018, 2018) The preoperative microbial detection is no prerequisite for the indication of septic revision in cases of suspected periprosthetic joint infection. Biomed Res Int. https://doi.org/10.1155/2018/1729605 CrossRef

32.

De Fine M, Giavaresi G, Fini M et al (2018) The role of synovial fluid analysis in the detection of periprosthetic hip and knee infections: a systematic review and meta-analysis. Int Orthop 42:983–994. https://doi.org/10.1007/s00264-018-3865-3 CrossRefPubMed

33.

Zahar A, Lausmann C, Cavalheiro C et al (2018) How reliable is the cell count analysis in the diagnosis of prosthetic joint infection? J Arthroplast 33:3257–3262. https://doi.org/10.1016/j.arth.2018.05.018 CrossRef

34.

Trampuz A, Hanssen AD, Osmon DR et al (2004) Synovial fluid leukocyte count and differential for the diagnosis of prosthetic knee infection. Am J Med 117:556–562. https://doi.org/10.1016/j.amjmed.2004.06.022 CrossRefPubMed

35.

Renz N, Yermak K, Perka C, Trampuz A (2018) Alpha defensin lateral flow test for diagnosis of periprosthetic joint infection: not a screening but a confirmatory test. J Bone Joint Surg Am 100:742–750. https://doi.org/10.2106/JBJS.17.01005 CrossRefPubMed

36.

Kelly MP, Darrith B, Hannon CP et al (2018) Synovial fluid alpha-defensin is an adjunctive tool in the equivocal diagnosis of periprosthetic joint infection. J Arthroplast 33:3537–3540. https://doi.org/10.1016/j.arth.2018.06.026 CrossRef

37.

Suda AJ, Tinelli M, Beisemann ND et al (2017) Diagnosis of periprosthetic joint infection using alpha-defensin test or multiplex-PCR: ideal diagnostic test still not found. Int Orthop 41:1307–1313. https://doi.org/10.1007/s00264-017-3412-7 CrossRefPubMed

38.

Morgenstern C, Cabric S, Perka C et al (2018) Synovial fluid multiplex PCR is superior to culture for detection of low-virulent pathogens causing periprosthetic joint infection. Diagn Microbiol Infect Dis 90:115–119. https://doi.org/10.1016/j.diagmicrobio.2017.10.016 CrossRefPubMed

39.

Alijanipour P, Adeli B, Hansen EN et al (2015) Intraoperative purulence is not reliable for diagnosing periprosthetic joint infection. J Arthroplast 30:1403–1406. https://doi.org/10.1016/j.arth.2015.03.005 CrossRef

40.

Biant LC, Bruce WJM, van der Wall H, Walsh WR (2010) Infection or allergy in the painful metal-on-metal total hip arthroplasty? J Arthroplast 25:334.e11–334.e16. https://doi.org/10.1016/j.arth.2008.08.015 CrossRef

41.

Rakow A, Schoon J, Dienelt A et al (2016) Influence of particulate and dissociated metal-on-metal hip endoprosthesis wear on mesenchymal stromal cells in vivo and in vitro. Biomaterials 98:31–40. https://doi.org/10.1016/j.biomaterials.2016.04.023 CrossRefPubMed

42.

Koper MC, Mathijssen NMC, Witt F et al (2016) Clinical and wear analyses of 9 large metal-on-metal total hip prostheses. PLoS One 11:e0163438. https://doi.org/10.1371/journal.pone.0163438 CrossRefPubMedPubMedCentral

43.

Peel TN, Spelman T, Dylla BL et al (2017) Optimal periprosthetic tissue specimen number for diagnosis of prosthetic joint infection. J Clin Microbiol 55:234–243. https://doi.org/10.1128/JCM.01914-16 CrossRefPubMed

44.

Zmistowski B, Della Valle C, Bauer TW et al (2014) Diagnosis of periprosthetic joint infection. J Arthroplast 29:77–83. https://doi.org/10.1016/j.arth.2013.09.040 CrossRef

45.

Parvizi J, Fassihi SC, Enayatollahi MA (2016) Diagnosis of periprosthetic joint infection following hip and knee arthroplasty. Orthop Clin North Am 47:505–515. https://doi.org/10.1016/j.ocl.2016.03.001 CrossRefPubMed

46.

Makki D, Abdalla S, El Gamal T et al (2018) Is it necessary to change instruments between sampling sites when taking multiple tissue specimens in musculoskeletal infections? Ann R Coll Surg Engl 100:563–565. https://doi.org/10.1308/rcsann.2018.0097 CrossRefPubMedPubMedCentral

47.

Trampuz A, Piper KE, Hanssen AD et al (2006) Sonication of explanted prosthetic components in bags for diagnosis of prosthetic joint infection is associated with risk of contamination. J Clin Microbiol 44:628–631. https://doi.org/10.1128/JCM.44.2.628-631.2006 CrossRefPubMedPubMedCentral

48.

Ochsner PE, Borens O, Bodler P-M, Schweizerische Gesellschaft für Orthopädie und Traumatologie (2014) Infections of the musculoskeletal system: basic principles, prevention, diagnosis and treatment

49.

Sigmund IK, Yermak K, Perka C et al (2018) Is the enzyme-linked immunosorbent assay more accurate than the lateral flow alpha defensin test for diagnosing periprosthetic joint infection? Clin Orthop Relat Res 476:1645–1654. https://doi.org/10.1097/CORR.0000000000000336 CrossRefPubMedPubMedCentral

50.

Parvizi J, Tan TL, Goswami K et al (2018) The 2018 definition of periprosthetic hip and knee infection: an evidence-based and validated criteria. J Arthroplast 33:1309–1314.e2. https://doi.org/10.1016/j.arth.2018.02.078 CrossRef

51.

Segreti J, Parvizi J, Berbari E et al (2017) Introduction to the Centers for Disease Control and Prevention and Healthcare Infection Control Practices Advisory Committee guideline for prevention of surgical site infection: prosthetic joint arthroplasty section. Surg Infect 18:394–400. https://doi.org/10.1089/sur.2017.068 CrossRef

52.

Johnson DP, Bannister GC (1986) The outcome of infected arthroplasty of the knee. J Bone Joint Surg (Br) 68:289–291CrossRef

53.

Tsukayama DT, Wicklund B, Gustilo RB (1991) Suppressive antibiotic therapy in chronic prosthetic joint infections. Orthopedics 14:841–844PubMed

54.

Trampuz A, Piper KE, Jacobson MJ et al (2007) Sonication of removed hip and knee prostheses for diagnosis of infection. N Engl J Med 357:654–663. https://doi.org/10.1056/NEJMoa061588 CrossRefPubMed

55.

Baker RP, Furustrand Tafin U, Borens O (2015) Patient-adapted treatment for prosthetic hip joint infection. Hip Int 25:316–322. https://doi.org/10.5301/hipint.5000277 CrossRefPubMed

56.

Izakovicova P, Borens O, Trampuz A (2019) Periprosthetic joint infection: current concepts and outlook. EFORT Open Rev 4:482–494. https://doi.org/10.1302/2058-5241.4.180092 CrossRefPubMedPubMedCentral

57.

Zhang C, Yan CH, Chan PK et al (2017) Polyethylene insert exchange is crucial in debridement for acute periprosthetic infections following total knee arthroplasty. J Knee Surg 30:36–41. https://doi.org/10.1055/s-0036-1579667 CrossRefPubMed

58.

Choi H-R, von Knoch F, Zurakowski D et al (2011) Can implant retention be recommended for treatment of infected TKA? Clin Orthop Relat Res 469:961–969. https://doi.org/10.1007/s11999-010-1679-8 CrossRefPubMed

59.

Zimmerli W (2014) Clinical presentation and treatment of orthopaedic implant-associated infection. J Intern Med 276:111–119. https://doi.org/10.1111/joim.12233 CrossRefPubMed

60.

Renner L, Perka C, Trampuz A, Renz N (2016) Treatment of periprosthetic infections. Chirurg 87:831–838. https://doi.org/10.1007/s00104-016-0255-5 CrossRefPubMed

61.

Bialecki J, Bucsi L, Fernando N et al (2019) Hip and knee section, treatment, one stage exchange: proceedings of International Consensus on Orthopedic Infections. J Arthroplast 34:S421–S426. https://doi.org/10.1016/j.arth.2018.09.026 CrossRef

62.

Segreti J, Nelson JA, Trenholme GM (1998) Prolonged suppressive antibiotic therapy for infected orthopedic prostheses. Clin Infect Dis 27:711–713. https://doi.org/10.1086/514951 CrossRefPubMed

63.

Giacometti Ceroni R, Bianchi L, Mondini A, Zagra L (2012) Peri-prosthetic infections. When to avoid surgery. Hip Int 22(Suppl 8):S75–S78. https://doi.org/10.5301/HIP.2012.9574 CrossRefPubMed

64.

Byren I, Bejon P, Atkins BL et al (2009) One hundred and twelve infected arthroplasties treated with “DAIR” (debridement, antibiotics and implant retention): antibiotic duration and outcome. J Antimicrob Chemother 63:1264–1271. https://doi.org/10.1093/jac/dkp107 CrossRefPubMedPubMedCentral

65.

Hyman JL, Salvati EA, Laurencin CT et al (1999) The arthroscopic drainage, irrigation, and débridement of late, acute total hip arthroplasty infections: average 6-year follow-up. J Arthroplast 14:903–910CrossRef

66.

Abouljoud MM, Backstein D, Battenberg A et al (2019) Hip and knee section, treatment, surgical technique: proceedings of International Consensus on Orthopedic Infections. J Arthroplast 34:S445–S451. https://doi.org/10.1016/j.arth.2018.09.029 CrossRef

67.

Pohlig F, Mühlhofer HML, Lenze U et al (2017) Diagnostic accuracy of arthroscopic biopsy in periprosthetic infections of the hip. Eur J Med Res 22:6. https://doi.org/10.1186/s40001-017-0246-0 CrossRefPubMedPubMedCentral

68.

Claassen L, Ettinger S, Pastor M-F et al (2016) The value of arthroscopic neosynovium biopsies to diagnose periprosthetic knee joint low-grade infection. Arch Orthop Trauma Surg 136:1753–1759. https://doi.org/10.1007/s00402-016-2574-x CrossRefPubMed

69.

Anagnostakos K, Meyer C (2019) Partial two-stage exchange at the site of periprosthetic hip joint infections. Arch Orthop Trauma Surg. https://doi.org/10.1007/s00402-019-03180-0 CrossRef

70.

El-Husseiny M, Haddad FS (2016) The role of highly selective implant retention in the infected hip arthroplasty. Clin Orthop Relat Res 474:2157–2163. https://doi.org/10.1007/s11999-016-4936-7 CrossRefPubMedPubMedCentral

71.

Muñoz-Mahamud E, García S, Bori G et al (2011) Comparison of a low-pressure and a high-pressure pulsatile lavage during débridement for orthopaedic implant infection. Arch Orthop Trauma Surg 131:1233–1238. https://doi.org/10.1007/s00402-011-1291-8 CrossRefPubMed

72.

Urish KL, DeMuth PW, Craft DW et al (2014) Pulse lavage is inadequate at removal of biofilm from the surface of total knee arthroplasty materials. J Arthroplast 29:1128–1132. https://doi.org/10.1016/j.arth.2013.12.012 CrossRef

73.

Hassinger SM, Harding G, Wongworawat MD (2005) High-pressure pulsatile lavage propagates bacteria into soft tissue. Clin Orthop Relat Res 439:27–31. https://doi.org/10.1097/01.blo.0000182246.37454.b2 CrossRefPubMed

74.

Soares D, Leite P, Barreira P et al (2015) Antibiotic-loaded bone cement in total joint arthroplasty. Acta Orthop Belg 81:184–190PubMed

75.

Tan TL, Kheir MM, Rondon AJ et al (2018) Determining the role and duration of the “antibiotic holiday” period in periprosthetic joint infection. J Arthroplast 33:2976–2980. https://doi.org/10.1016/j.arth.2018.04.019 CrossRef

76.

Preininger B, Janz V, von Roth P et al (2017) Inadequacy of joint aspiration for detection of persistent periprosthetic infection during two-stage septic revision knee surgery. Orthopedics 40:231–234. https://doi.org/10.3928/01477447-20170411-04 CrossRefPubMed

77.

Boelch SP, Weissenberger M, Spohn F et al (2018) Insufficient sensitivity of joint aspiration during the two-stage exchange of the hip with spacers. J Orthop Surg Res 13. https://doi.org/10.1186/s13018-017-0703-z

78.

Winkler T, Stuhlert MGW, Lieb E et al (2019) Outcome of short versus long interval in two-stage exchange for periprosthetic joint infection: a prospective cohort study. Arch Orthop Trauma Surg 139:295–303. https://doi.org/10.1007/s00402-018-3052-4 CrossRefPubMed

79.

Yusuf E, Jordan X, Clauss M et al (2013) High bacterial load in negative pressure wound therapy (NPWT) foams used in the treatment of chronic wounds. Wound Repair Regen 21:677–681. https://doi.org/10.1111/wrr.12088 CrossRefPubMed

80.

Abblitt WP, Ascione T, Bini S et al (2019) Hip and knee section, outcomes: proceedings of International Consensus on Orthopedic Infections. J Arthroplast 34:S487–S495. https://doi.org/10.1016/j.arth.2018.09.035 CrossRef

81.

Ibrahim MS, Raja S, Khan MA, Haddad FS (2014) A multidisciplinary team approach to two-stage revision for the infected hip replacement: a minimum five-year follow-up study. Bone Joint J 96-B:1312–1318. https://doi.org/10.1302/0301-620X.96B10.32875 CrossRefPubMed

82.

Laurent E, Lemaignen A, Gras G et al (2019) Multidisciplinary team meeting for complex bone and joint infections diagnosis: the PHICTOS study. Rev Epidemiol Sante Publique 67:149–154. https://doi.org/10.1016/j.respe.2019.01.121 CrossRefPubMed

83.

Ntalos D, Berger-Groch J, Rohde H et al (2019) Implementation of a multidisciplinary infections conference affects the treatment plan in prosthetic joint infections of the hip: a retrospective study. Arch Orthop Trauma Surg 139:467–473. https://doi.org/10.1007/s00402-018-3079-6 CrossRefPubMed

84.

Yan CH, Arciola CR, Soriano A et al (2018) Team approach: the management of infection after total knee replacement. JBJS Rev 6:e9. https://doi.org/10.2106/JBJS.RVW.17.00058 CrossRefPubMed

Titel: Twenty common errors in the diagnosis and treatment of periprosthetic joint infection
verfasst von: Cheng Li
Nora Renz
Andrej Trampuz
Cristina Ojeda-Thies
Publikationsdatum: 22.10.2019
Verlag: Springer Berlin Heidelberg
Erschienen in: International Orthopaedics / Ausgabe 1/2020
Print ISSN: 0341-2695
Elektronische ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-019-04426-7

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen.
» Jetzt entdecken

Neu im Fachgebiet Orthopädie und Unfallchirurgie

Notfall-TEP der Hüfte ist auch bei 90-Jährigen machbar

26.04.2024 Hüft-TEP Nachrichten

Ob bei einer Notfalloperation nach Schenkelhalsfraktur eine Hemiarthroplastik oder eine totale Endoprothese (TEP) eingebaut wird, sollte nicht allein vom Alter der Patientinnen und Patienten abhängen. Auch über 90-Jährige können von der TEP profitieren.

Arthroskopie kann Knieprothese nicht hinauszögern

25.04.2024 Gonarthrose Nachrichten

Ein arthroskopischer Eingriff bei Kniearthrose macht im Hinblick darauf, ob und wann ein Gelenkersatz fällig wird, offenbar keinen Unterschied.

Therapiestart mit Blutdrucksenkern erhöht Frakturrisiko

25.04.2024 Hypertonie Nachrichten

Beginnen ältere Männer im Pflegeheim eine Antihypertensiva-Therapie, dann ist die Frakturrate in den folgenden 30 Tagen mehr als verdoppelt. Besonders häufig stürzen Demenzkranke und Männer, die erstmals Blutdrucksenker nehmen. Dafür spricht eine Analyse unter US-Veteranen.

Ärztliche Empathie hilft gegen Rückenschmerzen

23.04.2024 Leitsymptom Rückenschmerzen Nachrichten

Personen mit chronischen Rückenschmerzen, die von einfühlsamen Ärzten und Ärztinnen betreut werden, berichten über weniger Beschwerden und eine bessere Lebensqualität.

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

Abstract

Background

Materials and methods

Results

Conclusion

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 1/2020

Conflicts, military medicine and war casualties in international Orthopaedics

Posterior cruciate ligament reconstruction for chronic lesions: clinical experience with hamstring versus ligament advanced reinforcement system as graft

Short stems reproduce femoral offset better than standard stems in total hip arthroplasty: a case-control study

Long-term outcome of total knee arthroplasty in patients with morbid obesity

Sleep improvement after hip arthroplasty: a study on short-stem prosthesis