Z Orthop Unfall 2017; 155(06): 655-660
DOI: 10.1055/s-0043-112247
Übersicht
Georg Thieme Verlag KG Stuttgart · New York

Diagnostik der periprothetischen Gelenkinfektion bei Schulterendoprothesen

Diagnosis of Periprosthetic Joint Infection of Shoulder Arthroplasties
Bernd Fink
1   Klinik für Endoprothetik, Allgemeine und Rheumaorthopädie, Orthopädische Klinik Markgröningen
2   Klinik für Orthopädie, Universitätsklinik Hamburg-Eppendorf
,
Florian Sevelda
1   Klinik für Endoprothetik, Allgemeine und Rheumaorthopädie, Orthopädische Klinik Markgröningen
3   Klinik für Orthopädie, Universitätsklinik Wien
› Author Affiliations
Further Information

Publication History

Publication Date:
12 July 2017 (online)

Zusammenfassung

Periprothetische Gelenkinfektionen sind eine der häufigsten Ursachen für Schmerzen und Revisionsoperationen bei Schulterendprothesen. Propionibacterium acnes ist einer der am häufigsten nachgewiesenen Keime und ist aufgrund des sehr langsamen Wachstums schwer zu identifizieren. Die verschiedenen Verfahren zur Verifizierung einer periprothetischen Schulterinfektion werden in dieser Arbeit dargestellt. Hierbei ist eine Kombination von unspezifischen und spezifischen (Keimisolation mit Antibiogramm) Testverfahren hilfreich, um eine periprothetische Infektion bestmöglich zu diagnostizieren. Ein Punktat des Gelenks erlaubt, verschiedene unspezifische und spezifische Testverfahren zu kombinieren. Bei einer Punctio sicca und Infektverdacht empfehlen wir die Biopsie des Gelenks.

Abstract

Periprosthetic joint infection of shoulder arthroplasties is one of the most frequent reasons for pain and revision surgery of shoulder arthroplasties. Propionibacterium acnes is one of the commonest microorganisms causing periprosthetic joint infection in shoulder arthroplasties. It is difficult to detect this slow growing microorganism. This paper gives an overview of the different diagnostic methods. A combination of unspecific and specific tests (detection of microorganism and sensitivity to antibiotics) is helpful in identifying a periprosthetic shoulder infection. Aspiration of the joint can combine different unspecific and specific tests. In patients with punctio sicca and suspected periprosthetic joint infection, we recommend biopsy of periprosthetic tissue.

 
  • Literatur

  • 1 Richards J, Inacio MC, Beckett M. et al. Patient and procedure-specific risk factors for deep infection after primary shoulder arthroplasty. Clin Orthop Relat Res 2014; 472: 2809-2815
  • 2 Beekman PD, Katusic D, Berghs BM. et al. One-stage revision for patients with a chronically infected reverse total shoulder replacement. J Bone Joint Surg Br 2010; 92: 817-822
  • 3 Hudek R, Gohlke F. [Endoprosthesis infections of the shoulder: diagnosis and therapy algorithm]. Orthopade 2013; 42: 552-559
  • 4 Padegimas EM, Maltenfort M, Ramsey ML. et al. Periprosthetic shoulder infection in the United States: incidence and economic burden. J Shoulder Elbow Surg 2015; 24: 741-746
  • 5 Singh JA, Sperling JW, Schleck C. et al. Periprosthetic infections after total shoulder arthroplasty: a 33-year perspective. J Shoulder Elbow Surg 2012; 21: 1534-1541
  • 6 Dennison T, Alentorn-Geli E, Assenmacher AT. et al. Management of acute or late hematogenous infection after shoulder arthroplasty with irrigation, debridement, and component retention. J Shoulder Elbow Surg 2017; 26: 73-78
  • 7 Pottinger P, Butler-Wu S, Neradilek MB. et al. Prognostic factors for bacterial cultures positive for Propionibacterium acnes and other organisms in a large series of revision shoulder arthroplasties performed for stiffness, pain, or loosening. J Bone Joint Surg Am 2012; 94: 2075-2083
  • 8 Nelson GN, Davis DE, Namdari S. Outcomes in the treatment of periprosthetic joint infection after shoulder arthroplasty: a systematic review. J Shoulder Elbow Surg 2016; 25: 1337-1345
  • 9 Wirth MA, Rockwood jr. CA. Complications of shoulder arthroplasty. Clin Orthop Relat Res 1994; 307: 47-69
  • 10 Singh JA, Sperling JW, Schleck C. et al. Periprosthetic infections after shoulder hemiarthroplasty. J Shoulder Elbow Surg 2012; 21: 1304-1309
  • 11 Piper KE, Jacobson MJ, Cofield RH. et al. Microbiologic diagnosis of prosthetic shoulder infection by use of implant sonication. J Clin Microbiol 2009; 47: 1878-1884
  • 12 Tsukayama DT, Estrada R, Gustilo RB. Infection after total hip arthroplasty. A study of the treatment of one hundred and six infections. J Bone Joint Surg Am 1996; 78: 512-523
  • 13 Aboltins CA, Dowsey MM, Buising KL. et al. Gram-negative prosthetic joint infection treated with debridement, prosthesis retention and antibiotic regimens including a fluoroquinolone. Clin Microbiol Infect 2011; 17: 862-867
  • 14 Berdal JE, Skramm I, Mowinckel P. et al. Use of rifampicin and ciprofloxacin combination therapy after surgical debridement in the treatment of early manifestation prosthetic joint infections. Clin Microbiol Infect 2005; 11: 843-845
  • 15 Martinez-Pastor JC, Munoz-Mahamud E, Vilchez F. et al. Outcome of acute prosthetic joint infections due to gram-negative bacilli treated with open debridement and retention of the prosthesis. Antimicrob Agents Chemother 2009; 53: 4772-4777
  • 16 Soriano A, Garcia S, Bori G. et al. Treatment of acute post-surgical infection of joint arthroplasty. Clin Microbiol Infect 2006; 12: 930-933
  • 17 Zimmerli W, Widmer AF, Blatter M. et al. Role of rifampin for treatment of orthopedic implant-related staphylococcal infections: a randomized controlled trial. Foreign-Body Infection (FBI) Study Group. JAMA 1998; 279: 1537-1541
  • 18 Fink B, Lass R. [Diagnostic algorithm for failure analysis of painful total hip arthroplasties]. Z Orthop Unfall 2016; 154: 527-544
  • 19 Padegimas EM, Lawrence C, Narzikul AC. et al. Future surgery after revision shoulder arthroplasty: the impact of unexpected positive cultures. J Shoulder Elbow Surg 2017; 26: 975-981
  • 20 Parvizi J, Gehrke T. International Consensus Group on Periprosthetic Joint Infection. Definition of periprosthetic joint infection. J Arthroplasty 2014; 29: 1331
  • 21 Fink B, Makowiak C, Fuerst M. et al. The value of synovial biopsy, joint aspiration and C-reactive protein in the diagnosis of late peri-prosthetic infection of total knee replacements. J Bone Joint Surg Br 2008; 90: 874-878
  • 22 Schafer P, Fink B, Sandow D. et al. Prolonged bacterial culture to identify late periprosthetic joint infection: a promising strategy. Clin Infect Dis 2008; 47: 1403-1409
  • 23 Virolainen P, Lahteenmaki H, Hiltunen A. et al. The reliability of diagnosis of infection during revision arthroplasties. Scand J Surg 2002; 91: 178-181
  • 24 Moroder P, Gerhardt C, Renz N. et al. Diagnostik und Management des Endoprotheseninfekts am Schultergelenk. Obere Extremität 2016; 11: 78-87
  • 25 Dodson CC, Craig EV, Cordasco FA. et al. Propionibacterium acnes infection after shoulder arthroplasty: a diagnostic challenge. J Shoulder Elbow Surg 2010; 19: 303-307
  • 26 Piper KE, Fernandez-Sampedro M, Steckelberg KE. et al. C-reactive protein, erythrocyte sedimentation rate and orthopedic implant infection. PLoS One 2010; 5: e9358
  • 27 Deirmengian C, Kardos K, Kilmartin P. et al. The alpha-defensin test for periprosthetic joint infection outperforms the leukocyte esterase test strip. Clin Orthop Relat Res 2015; 473: 198-203
  • 28 Parvizi J, Jacovides C, Antoci V. et al. Diagnosis of periprosthetic joint infection: the utility of a simple yet unappreciated enzyme. J Bone Joint Surg Am 2011; 93: 2242-2248
  • 29 Shafafy R, McClatchie W, Chettiar K. et al. Use of leucocyte esterase reagent strips in the diagnosis or exclusion of prosthetic joint infection. Bone Joint J 2015; 97-B: 1232-1236
  • 30 Ruangsomboon P, Chinprasertsuk S, Khejonnit V. et al. Effect of depth of centrifuged synovial fluid on leukocyte esterase test for periprosthetic joint infection. J Orthop Res 2017; DOI: 10.1002/jor.23561.
  • 31 Deirmengian C, Kardos K, Kilmartin P. et al. Combined measurement of synovial fluid alpha-Defensin and C-reactive protein levels: highly accurate for diagnosing periprosthetic joint infection. J Bone Joint Surg Am 2014; 96: 1439-1445
  • 32 Deirmengian C, Kardos K, Kilmartin P. et al. The alpha-defensin test for periprosthetic joint infection responds to a wide spectrum of organisms. Clin Orthop Relat Res 2015; 473: 2229-2235
  • 33 Shahi A, Parvizi J, Kazarian GS. et al. The alpha-defensin test for periprosthetic joint infections is not affected by prior antibiotic administration. Clin Orthop Relat Res 2016; 474: 1610-1615
  • 34 Frangiamore SJ, Saleh A, Grosso MJ. et al. Alpha-Defensin as a predictor of periprosthetic shoulder infection. J Shoulder Elbow Surg 2015; 24: 1021-1027
  • 35 Ince A, Seemann K, Frommelt L. et al. One-stage exchange shoulder arthroplasty for peri-prosthetic infection. J Bone Joint Surg Br 2005; 87: 814-818
  • 36 Tashjian RZ, Granger EK, Zhang Y. Utility of prerevision tissue biopsy sample to predict revision shoulder arthroplasty culture results in at-risk patients. J Shoulder Elbow Surg 2017; 26: 197-203
  • 37 Atkins BL, Athanasou N, Deeks JJ. et al. Prospective evaluation of criteria for microbiological diagnosis of prosthetic-joint infection at revision arthroplasty. The OSIRIS Collaborative Study Group. J Clin Microbiol 1998; 36: 2932-2939
  • 38 Pandey R, Drakoulakis E, Athanasou NA. An assessment of the histological criteria used to diagnose infection in hip revision arthroplasty tissues. J Clin Pathol 1999; 52: 118-123
  • 39 Barrack RL, Jennings RW, Wolfe MW. et al. The Coventry Award. The value of preoperative aspiration before total knee revision. Clin Orthop Relat Res 1997; (345): 8-16
  • 40 Duff GP, Lachiewicz PF, Kelley SS. Aspiration of the knee joint before revision arthroplasty. Clin Orthop Relat Res 1996; 331: 132-139
  • 41 Franceschini V, Chillemi C. Periprosthetic shoulder infection. Open Orthop J 2013; 7: 243-249
  • 42 Levitsky KA, Hozack WJ, Balderston RA. et al. Evaluation of the painful prosthetic joint. Relative value of bone scan, sedimentation rate, and joint aspiration. J Arthroplasty 1991; 6: 237-244
  • 43 Mont MA, Waldman BJ, Hungerford DS. Evaluation of preoperative cultures before second-stage reimplantation of a total knee prosthesis complicated by infection. A comparison-group study. J Bone Joint Surg Am 2000; 82-A: 1552-1557
  • 44 Gollwitzer H, Diehl P, Gerdesmeyer L. et al. [Diagnostic strategies in cases of suspected periprosthetic infection of the knee. A review of the literature and current recommendations]. Orthopade 2006; 35: 904 906–908, 910–906
  • 45 Ince A, Rupp J, Frommelt L. et al. Is “aseptic” loosening of the prosthetic cup after total hip replacement due to nonculturable bacterial pathogens in patients with low-grade infection?. Clin Infect Dis 2004; 39: 1599-1603
  • 46 Saper D, Capiro N, Ma R, Li X. Management of Propionibacterium acnes infection after shoulder surgery. Curr Rev Musculoskelet Med 2015; 8: 67-74
  • 47 Costerton JW. Biofilm theory can guide the treatment of device-related orthopaedic infections. Clin Orthop Relat Res 2005; (437): 7-11
  • 48 Gallo J, Kolar M, Novotny R. et al. Pathogenesis of prosthesis-related infection. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2003; 147: 27-35
  • 49 Neut D, van Horn JR, van Kooten TG. et al. Detection of biomaterial-associated infections in orthopaedic joint implants. Clin Orthop Relat Res 2003; 261-268
  • 50 Ahsan ZS, Somerson JS, Matsen 3rd FA. Characterizing the Propionibacterium load in revision shoulder arthroplasty: a study of 137 culture-positive cases. J Bone Joint Surg Am 2017; 99: 150-154
  • 51 Dilisio MF, Miller LR, Warner JJ. et al. Arthroscopic tissue culture for the evaluation of periprosthetic shoulder infection. J Bone Joint Surg Am 2014; 96: 1952-1958