Evaluation of the standard procedure for the treatment of periprosthetic joint infections (PJI) in Germany - results of
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(2020) 21:694
RESEARCH ARTICLE
Open Access
Evaluation of the standard procedure for the treatment of periprosthetic joint infections (PJI) in Germany - results of a survey within the EndoCert initiative Christina Rimke1†, Andreas Enz1*† , Hermann Josef Bail2, Peter Heppt3, Bernd Kladny4, Gabriela von Lewinski5, Christoph H. Lohmann6, Katrin Osmanski-Zenk1, Holger Haas7 and Wolfram Mittelmeier1
Abstract Background: The periprosthetic joint infection (PJI) is a severe complication in the field of arthroplasty. Despite the rising number of primary joint replacements, no unified therapeutic standard has been established for the treatment of PJI yet. Methods: A survey on the principles of treatment of PJI in Germany was conducted. A total of 515 EndoProthetikZentren (EPZ) were included, resulting in a response rate of 100%. Results: For early infections 97.6% of the centers use prosthesis-preserving procedures (DAIR). A one-stage exchange was implemented by less than 50% of the centers. If implemented, this treatment entails a prior selection of patients for a successful treatment. The two-stage exchange is performed in all centers, and most centers proceed with the implantation of a cemented spacer between stages. 75% of the centers proceed with a center-based concept for the treatment of PJI. Conclusion: The aim of a uniform PJI standard at the centers has not yet been fully achieved. Further improvements within the certification were initiated. The most relevant treatment options in Germany are displayed. The two-stage revision with a cemented spacer is the most widely implemented treatment. This exposition of principles could help for the further development of standardized treatment guidelines and definitions. Keywords: Revision arthroplasty, Two-stage revision, Periprosthetic joint infection, Certification, Incident reporting, Surveys
Background Joint replacement in end-stage joint diseases has been a well established and globally widespread surgical treatment method. Approximately 448.000 joint replacements are carried out in Germany every year [1]. Periprothestic joint infection (PJI) may occur in 0.2–2% of primary joint arthroplasty and up to 9% in implantation of megaprotheses * Correspondence: [email protected] † Christina Rimke and Andreas Enz contributed equally to this work. 1 Orthopädische Klinik und Poliklinik, Universitätsmedizin Rostock, Doberaner Straße 142, 18059 Rostock, Germany Full list of author information is available at the end of the article
[2–4]. Due to demographic change and an increased functional demand of patients, an increase in primary implantation of endoprostheses is expected and thus an increase in the absolute number of PJI [5–7]. In implant loosening, infection already represents one of the most frequent indication for revision surgery. Incidence rates are up to 30%, in addition to loosening of aseptic prostheses [1, 8–10]. PJI are associated with challenging diagnostic and therapeutic procedures and is one of the most serious complications [7, 11, 12]. Embedde
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