[Septic revision arthroplasty: how to confirm diagnosis, plan surgery and manage follow-up treatment].

BACKGROUND

Septic revision arthroplasty represents an interdisciplinary challenge in terms of diagnosis as well as surgical and follow-up treatment.

DIAGNOSIS: The implementation of a standardized diagnostic algorithm including anamnesis, clinic, imaging, blood sampling and joint aspiration is essential. Depending on the duration of the symptoms acute (< 3 weeks) and chronic (> 3 weeks) infections are distinguished.

THERAPY: While acute infections show an immature biofilm and can usually be addressed surgically via debridement and changing the mobile parts, chronic infections almost always require a complete change of the implant. This can be done in one or two stages, depending on the general condition of the patient, the pathogen, its resistances as well as the wound conditions. The surgical revision is always followed by a resistance-based antibiotic treatment.