Complication management of infected osteosynthesis. Therapy algorithm for peri-implant infections

Background. Peri-implant infections (PII) are one of the most frequent postoperative complications and require an individualized combined surgical and antibiotic management. In this review article we provide up to date scientific knowledge regarding the pathogenesis, classification, diagnosis and therapy of PII. The aim of this article is to explain the rational background and evidence of individual treatment options in order to elaborate concrete management recommendations. Materials and methods. The relevant scientific publications were critically reviewed for diagnostics, therapy and prevention of PII. Based on these data we present a combined surgical and antibiotic treatment algorithm for PII. Results. With a consistent interdisciplinary action high healing rates with eradication of PII can be achieved. In acute PII (< 6 weeks) the implant can normally be retained but this is dependent on the soft tissue conditions, while in chronic PII (> 6 weeks) the implant generally has to be removed in a one or two step exchange, depending on the soft tissue, bone defects and pathogen. Conclusion. Scientific knowledge and clinical data have led to new treatment algorithms for PII with improved outcome, decreased morbidity and shortened hospitalization. Systemic individualized antimicrobial therapy, radical septic and plastic surgery are the cornerstones for successful treatment of acute and chronic PII. The local use of antibiotics and application of bone substitute materials are other techniques for treatment but the exact importance must still be determined.