Gelenkinfekt - eine Entität für die spezielle septische Chirurgie.

Background: Joint infections can cause severe complications that result in irreversible joint destruction when treated inadequately. Pathogenesis: Reasons for joint infections consist of endogenous hematological and exogenous factors. Patients acquire empyema almost solely through iatrogenic measures (e.g. arthroscopic operations, punctures and intra-articular infections) or as a result of near joint fractures and penetrating injuries. Diagnosis: To make a correct diagnose, a joint puncture with a direct swab test is necessary in addition to laboratory examinations, x-ray and magnetic resonance imaging (MRI) examinations. The leucocyte count must be determined (threshold value 25,000/μl) as well as a gram stain to microscopically identify possible bacteria present. Therapy: Acute joint infections are considered to be orthopedic emergencies necessitating immediate surgical treatment as irreversible cartilage damage can rapidly result due to the pathophysiological process. Acute joint empyema should be treated arthroscopically. Clinical symptoms lasting more than 7 days emanate in chronic empyema and should be treated by arthrotomy, synovialectomy and removal of extraneous material including a possible cruciate ligament replacement. Postoperatively, an immediate intensive physiotherapy is necessary, even under the use of pain catheters. The transfer to a centre for septic surgery is recommended. [ABSTRACT FROM AUTHOR]