Periprosthetic infection

Periprosthetic infections represent the most feared complications in orthopedic surgery. Frequently, the substantial challenges result more from a delayed diagnosis and an inadequate therapy than from the infection itself. The guiding symptom is pain. The determination of C-reactive protein (CRP) and the blood sedimentation rate (BSR) is the basic screening test for infection while joint aspiration is commonly used to confirm the diagnosis. Infection treatment with implant preservation is only promising and justifiable in the early postoperative infection period. The current concept of infection treatment consists of a two-stage revision with 6-8 weeks implant-free interval and an accompanying antibiotic therapy. The one-stage revision is the patient friendliest procedure but requires strict prerequisites which may not be given in a number of cases. The reported mean success rates range from 80-100% with the respective therapeutic procedures. However, there is no single evidenced-based therapeutic concept throughout the whole course of treatment but frequently a various number of individual modifications. Nevertheless, a clear strategy in treatment planning using objective criteria without subjective decisions and emotions is essential for the success of therapy. If the healing rate falls under 80% the applied concept must be reconsidered.