3 months! - Septische Chirurgie

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Question No. 465-y-old surgeon. Progressive shoulder pain sinceimplantation 1 year ago. 1 month ago fistula occurredwith growth of S. epidermidis in fistula swab. What wouldyou suggest?a) Ciprofloxacin + rifampicin p.o.b) Debridement and retentionc) 1-stage exchanged) 2-stage exchange with short (2-week) intervale) 2-stage exchange with long (6-week) interval
1-step exchange• Preop. known germ• Easy to treat germ(Rifampicin sensitive)• Local and systemicAB• Good soft tissues (Nodraining sinus)• « Tumor surgery »Success rate 85%Zimmerli W. NEJM 2004
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O. Borens A. TrampuzInterdisziplin
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Trampuz A, Borens O. RMS 2011We can
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BacteriostaticBactericidalTETRACYCL
Page 9 and 10:
Frequent errors in systemic AB TT
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• 10/06/2011: Arthroscopy (medial
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• 17/08/2011: Increasing, invalid
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• 24/09/2011: Leaves hospital- Af
Page 17 and 18:
Treatment• 09/11/2011: extensives
Page 19 and 20:
After 8 days• 17/11/2011: removal
Page 22 and 23:
Teamwork!
Page 24 and 25:
Three types of implant infectionTim
Page 26 and 27:
Question No. 1A patient about pain,
Page 28 and 29:
Joint aspirationImportant:1. Native
Page 30 and 31:
Question No. 267-y: Increasing pain
Page 32 and 33:
Planktonic modeBiofilm modeProblem
Page 34 and 35: 5/2008• Arthroscopy right knee
Page 36 and 37: 19.11.08• Important redicular pai
Page 38 and 39: 14.9.2009Fever, Chills, CRP 123Spin
Page 40 and 41: TKATherapeutic optionsa. Nihilb. Me
Page 42 and 43: 24.11.2009• Postoperative procedu
Page 44 and 45: 18.1.2010• Revision total knee- T
Page 46 and 47: 19.2.2010Ongoing AB; CRP 19
Page 48 and 49: 22.3.2010• No back pain• Knee i
Page 50 and 51: 29.3.2010Persistant pain, CRP 22
Page 52 and 53: 4.5.2010Neg. biopsy and negativaspi
Page 54 and 55: 20.7.2011• Arthrotomy with biopsi
Page 56 and 57: 5.9.2011Local situation with soft t
Page 58 and 59: 14.12. 2011• Persistant pain, dif
Page 60 and 61: 4.1.12• Tap:no growth, no cytolog
Page 62 and 63: What shall we do?• Next steps- Mo
Page 64 and 65: 24.1.2012• Tremor left sided• K
Page 66 and 67: What now?• Which exams:- Histolog
Page 68 and 69: 22.2.2012• RHK (Zimmer)
Page 70 and 71: 17.4.2012• Walks 1,5 km• Back h
Page 72 and 73: 21.8.2012
Page 74 and 75: SonicationMechanical vibrations >20
Page 76 and 77: Suppression• Patients to sick to
Page 78 and 79: Question No. 385-y-old biologist. H
Page 80 and 81: 69 y.o. TKA 2004 (5 y po)Symptoms s
Page 82 and 83: Débridement with retention of TKA(
Page 86 and 87: 2-step exchange• With spacer- AB-
Page 88 and 89: Prolonged Vac therapy• Is not a t
Page 90 and 91: Confirmed infection:Mirror sign +
Page 92 and 93: Cement spacer and secondary closure
Page 94 and 95: Microbiologie•Augmentin jusqu’a
Page 96 and 97: 6 months later
Page 98 and 99: Treatment concepts 2013Debridementa
Page 100 and 101: Byren. AAC 2012
Page 103 and 104: Difficult to treat organisms• Rif
Page 105 and 106: Median (days)Interval from explanta
Page 107 and 108: Take home message1. Implant can be
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3 months! - Septische Chirurgie

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