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CC BY-NC-ND 4.0 · Rev Bras Ortop (Sao Paulo) 2021; 56(05): 621-627
DOI: 10.1055/s-0041-1729941
Artigo de Atualização
Infectologia

Infection after primary total knee arthroplasty: a randomized controlled prospective study of the addition of antibiotics to bone cement[*]

Article in several languages: português | English
Hugo Alexandre de Araujo Barros Cobra 
1   Centro de Atenção Especializada em Cirurgia do Joelho, Instituto Nacional de Traumatologia e Ortopedia, Rio de Janeiro, RJ, Brasil
,
Alan de Paula Mozella 
1   Centro de Atenção Especializada em Cirurgia do Joelho, Instituto Nacional de Traumatologia e Ortopedia, Rio de Janeiro, RJ, Brasil
,
Pedro José Labronici 
2   Departamento de Ortopedia e Traumatologia, Universidade Federal Fluminense, Niterói, RJ, Brasil
,
Amanda S. Cavalcanti    *
3   Divisão de Pesquisa, Instituto Nacional de Traumatologia e Ortopedia, Rio de Janeiro, RJ, Brasil
,
João Antonio Matheus Guimarães 
3   Divisão de Pesquisa, Instituto Nacional de Traumatologia e Ortopedia, Rio de Janeiro, RJ, Brasil
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Abstract

Objective The present prospective, randomized and controlled study was conducted with 286 patients submitted to primary total knee arthroplasty (TKA) with the objective of evaluating the efficacy of the addition of antibiotics to bone cement as a way to prevent post arthroplasty infection (PAI).

Methods The patients were randomized into two groups: bone cement without antibiotic (No ATB, n = 158) or cement with antibiotic (ATB, n = 128), in which 2 g of vancomycin was added to 40 g of cement. The patients were followed up for 24 months after surgery.

Results Regarding preoperative demographic data, the distribution of patients between groups was homogeneous (p < 0.05). In the 24-month period, the overall infection rate was of 2.09% (6/286), with no difference (odds ratio [OR] = 1.636; 95% confidence interval [CI]: 0.294–9.080; p = 0.694) between the ATB group (1.56%; 2/128) and the No ATB group (2.53%; 4/158). In the No ATB group, the infection was caused by methicillin-resistant Staphylococcus aureus (MRSA) (n = 2), methicillin-sensitive S. aureus (MSSA) (n = 1) and Eschirichia coli (n = 1). Proteus mirabilis and MSSA were isolated from patients in the ATB group. Among the comorbidities, all patients with PAI were hypertensive and nondiabetic. Two rheumatoid arthritis patients who developed PAI were from the ATB group.

Conclusion The use of cement with ATB reduced the absolute number of infections, but without statistical difference between the groups; thus, routine use should not be encouraged.

Keywords

antibiotic - arthroplasty, replacement, knee - bone cements - prosthesis-related infections

* Study developed at the Instituto Nacional de Traumatologia e Ortopedia (INTO), Rio de Janeiro, RJ, Brazil.


Supplementary Material



Publication History

Received: 27 July 2020

Accepted: 01 December 2020

Article published online:
28 October 2021

© 2021. Sociedade Brasileira de Ortopedia e Traumatologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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