Objectives: An osteitis of the tibia remains a major problem especially in cases of open tibial fractures. A successful therapy management goes along with a radical bacterial eradication, sufficient soft tissue coverage, and a stable osseous reconstruction.

Methods: The study population consists of 112 patients (53 ± 13 years). All of them suffered from a tibial osteitis after fracture of the tibia. The study population was divided in patients with osteitis after open versus non open tibial fracture. The therapy strategy was the same in both groups. It was done according to a standardised treatment plan including radical surgical eradication of infectious and necrotic tissue, programmed lavage with vacuum sealing in combination with an effective bacterial antibiotic therapy. Surgical stabilization was done in cases of instability. Final osseous reconstruction and soft tissue coverage was performed if necessary after three negative intraoperative smears.

Results: 89 patients of the patients (79%) suffered form open tibial fractures versus 23 (21%) patients with non open fractures (NOF). The average inpatient treatment time was 13 ± 18 weeks in cases of osteitis after open tibial fractures and 8 ± 4 weeks after NOF. The average number of operative procedures after open fractures vs NOF was 10 ± 7 vs 8 ± 4. In 55 patients a muscle flap procedure was performed after open tibial fractures (53%) versus 9 (26%) after NOF. An amputation of the lower leg had to be done in 5 patients after open tibial fractures (5%) versus in 2 patients after NOF (6%). The rate of bacterial eradication with no recurrence of infection for at least one year was 53% in cases of osteitis after open tibial fracture and 65% after NOF.

Conclusion: An open fracture of the tibia is a major risk factor for developing a chronic osteitis. The eradication of bacterial infections takes a longer time and more operative procedures are necessary in cases of open tibial fractures versus closed fractures. In cases of open fractures there exists a higher need of soft tissue reconstruction by muscle flaps. After eradication there are no significant differences in the one year recurrence rate.

Objectives: This study evaluates the number of recurrence of acute infection following total knee arthroplasty treated with a concept of implant salvage using programmed revision surgery and specific long-term antibiotic therapy with and without additional application of antibiotics penetrating bacterial biofilms like rifampicin.

Methods: In a retrospective study, 24 patients with early infection of unconstrained total knee arthroplasty were treated according to our protocol and were followed up for a period of 4 years [range 1,2–6,2]

using a questionnaire to investigate course of disease and health-related quality of life (VAS). 7 patients were treated with and 17 patients without additional application of antibiotics penetrating bacterial biofilms.

Results: In the group of patients treated without additional application of antibiotics penetrating bacterial biofilms 11 of 17 (65%) implants were salvaged. In 5 cases revision arthroplasty and 1 arthrodesis were necessary to eradicate infection. Health-related quality of life and function of the arthroplasy were superior in the group of salvaged implants.

In the group of patients treated with additional application of antibiotics penetrating bacterial biofilms 6 of 7 (86%) implants were salvaged and reduced number of revison surgery was needed.

Conclusion: Treatment of infection with implant salvage may be one therapeutic option if the implant is not loose. Therapy with retention of the prosthesis may be indicated: in the case of early infection (< 3 weeks of ongoing symptoms), with unconstrained implants, in the case of infection by a single organism that is susceptible to antibiotic therapy, if soft tissue envelope is not affected, and if the immune system is not compromised. Early and consequent therapy with operative debridements and specific long-term antibiotic therapy are necessary to achieve implant salvage. Additional application of antibiotics penetrating bacterial biofilms such as rifampicin contribute to improve prognosis.

Due to the fact that revision arthroplasty is often associated with limited function after infection of total knee joint, retention of the implant has to be considered a therapeutic alternative in early infection.