Septic arthritis of joint replacements in patients with rheumatic diseases

Infections of joint arthroplasties are rare but may result in intense complications, especially in patients with rheumatic diseases. Immediate diagnostic procedures are indicated, such as punction of the joint in question under definitive sterile conditions, followed by inspection of the material, identification of bacteria and synovia analysis. The initial broad-spectrum antibiotic treatment is begun thereafter, only later is specific therapy indicated, when the bacteria have been defined. The immediate surgical intervention is necessary when an infection could be ascertained and is oriented according to time interval after implantation, soft-tissue situation, virulence of bacteria, the patient him/herself and his/her medication as well as laboratory results and radiological findings. Very early infections may occasionally still be treated without removal of the prosthesis while chronic infections seldom rectify single-step replacements. In general two-step replacement interventions are required, consisting in a first explantation of the prosthesis with a spacer-intermediate (cement/custom-made) under inclusion of antibiotics (accompanied with systemic antibiotic medication). After repeated bacteria-free punction and a time-lag of 6 - 12 weeks the replantation of an endoprosthesis may be considered. In many cases after joint replacement infection, reconstructive surgery is necessary, including arthrodesis up to amputation.