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Periprosthetic joint infection (PJI) is among the most serious complications in the field of endoprosthetics. The number of PJIs is increasing worldwide and poses a real interdisciplinary challenge for everyone involved. For the patient concerned, it is necessary to promptly work out an adequate therapy solution to fight off the infection. Both the clinical experience of the surgeon and the proper diagnostic processes are prerequisite for the reliable detection and identification of an infection. The microbiologist is responsible for identifying the causative germs by screening the patient’s synovial fluid and tissue samples. Based on the findings and subsequent resistance testing, the infectious disease specialist can recommend the appropriate antibiotic therapy. Furthermore, the clinical pharmacist is consulted regularly throughout the therapy to discuss the risk of potential drug interactions. The surgeon will proceed with the revision surgery, following defined algorithms. Adequate radical debridement of infected and necrotic surrounding tissue is the most important step towards a successful cure of the infection. Accompanying the surgery, anti-infective agents are given systemically and locally. While systemic application of anti-infectives mainly reduces the number of haematogenic-spreading planktonic germs, local application immediately forms a colonization barrier and protects the implant from sessile biofilm formation. Concurrently, antibiotics are actively released from the implant, resulting in local germ reduction. Thus, local agents are embedded in the concept of surgical PJI treatment as a reliable adjuvant measure and they sustainably support the successful outcome. In one-stage procedures, local agents are released from specialized antibiotic-loaded bone cements, while in two- or multi-stage procedures, local agents are released from corresponding temporary spacers (interim prostheses). Even from an economic standpoint, the combination of systemic and local agent application is meaningful. Furthermore, there are some interesting trends towards the coating of metallic implants to protect against biofilm formation on the implant surface. On the basis of their personal experience, specialists from all over the world present, explain and discuss preventive approaches, appropriate diagnostic strategies for detection, reproducible effective surgical treatments  as well as the economic impact of PJI. The reader can use this book as a solid platform for comparing their own approach to PJI treatment with the specialists’ recommendations.  .

Medicine. --- Orthopedics. --- Medicine & Public Health. --- Orthopedic implants --- Complications --- Implants, Orthopedic --- Implants, Artificial --- Orthopedic apparatus --- Orthopedic surgery --- Prosthesis --- Orthopaedics --- Orthopedia --- Surgery

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Orthopaedics. Traumatology. Plastic surgery --- orthopedie

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Musculosketal infections are potentially devastating for the patient, his family and the health care services, as they may lead to functional impairment, long lasting disability, or even permanent handicap. This problem may also have socioeconomic implications. Infection commonly results in prolonged use of antibiotics, multiple operations, complications, extended rehabilitation and long lasting follow-up visits with additional costs for the health care provider. The 2nd International Arthroplasty Symposium žThe Infected Implant" brought together international experts and will concentrate on infections: development, microbiology, diagnostics, statistics and therapy of the infected implant. Concerning microbiological diagnostics, a major challenge is the differentiation between septic and aseptic prosthesis loosening. Biofilm formation at low grade infections will therefore be one of our main topics at the event in 2008. Furthermore, the issue of antibiotic resistances, which is always a hot topic,will be discussed, based on new clinical and epidemiological data.These days, a number of options for the therapy of the infected implant are available. Lectures about the rational use of antibiotic medication and theapplication of antibiotic containing spacers will represent key topics of this meeting. The question whether revision surgery should be cemented or not will be another subject of the panel discussion, where clinicians of different countries worldwide will present their revision cases. A third part of the symposium will cover consequences and economical aspects of infected implants. The speakers will focus on the different European Arthroplasty Registers, but the issue of reimbursement practices within the EU will also be discussed.

Orthopaedics. Traumatology. Plastic surgery --- orthopedie