Treatment of chronic orthopaedic infection

[摘要] Most orthopaedic infections arise as sequela to traumatic episodes and during surgery, especially when foreign material is implanted, as in osteosynthesis or total joint replacement (TJR). Bacteria, mostly staphylococci, are able to bind to damaged tissue and implanted material with immediate formation of biofilms that may be considered mature after several days. Clinical signs persisting for longer than ten days are associated with the development of necrotic bone and chronic osteomyelitis (COM). COM and prosthetic joint infection (PJI) are characterised by the persistence of microorganisms on dead bone and implants, causing low-grade inflammation with occasional acute episodes, eventually associated with fistulous tracts. Removal of dead material is a prerequisite for cure. However, there is no consensus on the time interval between debridement and definitive reconstruction. The second procedure is mostly performed when clinical findings and laboratory parameters have returned to normal. In the meantime, external fixators and/or spacers will provide some temporary stabilisation while systemic and/or local antibiosis will sterilise the infected site. However, the prolonged hospitalisation and its associated costs, the delayed mobilisation and rehabilitation, and the risk of multiple surgery are marked drawbacks, especially in elderly patients. Is it worthwhile to wait?.

[学科分类] 神经科学

[关键词] chronic orthopaedic infection;biofilm;chronic osteomyelitis;prosthetic joint infection;antibiotic delivery;bone defect;effective therapy