Antimicrobial treatment of patients with a periprosthetic joint infection: basic principles.

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Abstract

Conflict of interest statement: The authors report no conflict of interest. 15. Z Orthop Unfall. 2021 Oct;159(5):565-582. doi: 10.1055/a-1149-9654. Epub 2020 Sep 30. [Revision Total Knee Arthroplasty]. [Article in German] Kremer M, Gramlich Y, Hoffmann R. In addition to periprosthetic infections (PJI), the reconstruction of bony defects is the major challenge of revision total knee arthroplasty (TKA). Infection should be ruled out in all cases prior to operation. Revision TKA requires intensive planning with regard to the needed augmentation possibilities and the stems to be used. The sole biological reconstruction of major defects (AORI II and III) shows high failure rates. Large defects must be augmented by metal (wedges/sleeves/cones). The concept of zonal anchorage (3-zone model) with a stable anchorage in 2 out of 3 zones as close to the joint as possible is currently the standard. According to the model, metaphysis (zone 2) is an increasingly important factor for long-term stable anchoring. The use of cones or sleeves seems to significantly improve the results of revision TKA. The anchorage in zone 3 via stems is still mandatory. Cemented metaphysary anchoring and cement-free diaphysary anchoring stems are available, whereby no clear recommendation for a principle can be given. Thieme. All rights reserved. DOI: 10.1055/a-1149-9654