Periprosthetic infection: diagnosis and treatment. Part 2 (literature review)
Keywords:joint arthroplasty, periprosthetic infection, surgical treatment, single-stage revision, two-stages revision, open debridment
AbstractJoint arthroplasty is the most effective surgery in the orthopedic practice, that significantly improves quality of life in patients with hip and knee joint diseases with the different etiology. Hence, any surgery has complication, one of the most severe is a periprosthetic infection (PPI). Clinical polymorphism and nonspecific diagnostic tests determine difficulties in PPI diagnostic. Microorganisms ability to biofilm formation with antibacterial agents resistance burdens treatment process. Systematization of scientific information presented in the world profession literature is presented in the article, for the main treatment principles determination. It is showed, that nonadequate and untimely performed treatment has catastrophic outcomes. Treatment cost of these complication increase 4–5 fold to primary arthroplasty. The authors analyzed various possibilities of modern methods of treatment of infectious complications in order to preserve joint function. Described available treatments (surgical and conservative) of the indicated pathology. Described an essence of surgical techniques (single-stage and two-stages revision, open debridment), presented their comparative characteristics and their indications. Emphasized that the difficulties appear as well as at the stage of diagnosis and treatment of PPI. Diagnosis must rely solely on objective measures. The choice of treatment strategy should be based on a thorough analysis of the results of diagnostic studies (type of infection and type of pathogen virulence, sensitivity to antibiotics, duration of symptoms, the patient's general condition, etc.). Emphasized maximum attention to the need for early and complete diagnosis of acute infection. In the case of chronic infection thorough diagnosis will help ensure the best results.
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