Infecção após artroplastia total primária de joelho: estudo randomizado prospectivo controlado da adição de antibiótico ao cimento ósseo^[*]

Resumo

Objetivo O presente estudo prospectivo, randomizado e controlado foi realizado com 286 pacientes submetidos à artroplastia total primária do joelho (ATJ) com o objetivo de avaliar a eficácia da adição de antibiótico ao cimento ósseo como forma de prevenção da infecção pós-artroplastia (IPA).

Métodos Os pacientes foram randomizados em dois grupos: cimento ósseo sem antibiótico (Sem ATB, n = 158) ou cimento com antibiótico (Com ATB, n = 128), ao qual foram adicionados 2 g de Vancomicina para 40 g de cimento. Os pacientes foram acompanhados por 24 meses após a cirurgia.

Resultados No que diz respeito aos dados demográficos pré-operatórios, a distribuição dos pacientes entre os grupos foi homogênea (p < 0,05). No período de 24 meses, a taxa global de infecção foi de 2,09% (6/286), não havendo diferença (odds ratio [OR] = 1,636; intervalo de confiança [IC] 95%: 0,294–9,080; p = 0,694) entre o grupo Com ATB (1,56%; 2/128) e Sem ATB (2,53%; 4/158). No grupo Sem ATB, a infecção foi causada por Staphylococcus aureus resistente à meticilina (MRSA, na sigla em inglês) (n = 2), S. aureus sensível à meticilina (MSSA, na sigla em inglês) (n = 1) e Eschirichia coli (n = 1). Proteus mirabilis e MSSA foram isolados dos pacientes do grupo Com ATB. Dentre as comorbidades, todos os pacientes com IPA eram hipertensos e não diabéticos. Dois pacientes com artrite reumatoide que desenvolveram IPA eram do grupo Com ATB.

Conclusão O uso de cimento com ATB reduziu o número absoluto de infecções; porém, sem diferença estatística entre os grupos. Desta forma, o uso rotineiro não deve ser encorajado.

Palavras-chave

antibiótico - artroplastia do joelho - cimentos ósseos - infecções relacionadas à prótese

^* Trabalho desenvolvido no Instituto Nacional de Traumatologia e Ortopedia (INTO), Rio de Janeiro, RJ, Brasil.

Publikationsverlauf

Eingereicht: 27. Juli 2020

Angenommen: 01. Dezember 2020

Artikel online veröffentlicht:
28. Oktober 2021

• Referências

• 1 Laffer RR, Graber P, Ochsner PE, Zimmerli W. Outcome of prosthetic knee-associated infection: evaluation of 40 consecutive episodes at a single centre. Clin Microbiol Infect 2006; 12 (05) 433-439
• 2 Daines BK, Dennis DA, Amann S. Infection prevention in total knee arthroplasty. J Am Acad Orthop Surg 2015; 23 (06) 356-364
• 3 Delanois RE, Mistry JB, Gwam CU, Mohamed NS, Choksi US, Mont MA. Current Epidemiology of Revision Total Knee Arthroplasty in the United States. J Arthroplasty 2017; 32 (09) 2663-2668
• 4 Cobra H. Causas de falha de artroplastia total de joelho. Rev INTO. 2009; 7 (04) 11-18
• 5 Qadir R, Sidhu S, Ochsner JL, Meyer MS, Chimento GF. Risk stratified usage of antibiotic-loaded bone cement for primary total knee arthroplasty: short term infection outcomes with a standardized cement protocol. J Arthroplasty 2014; 29 (08) 1622-1624
• 6 Frazão VL, Miyahara HS, Kirihara RA, Lima ALLM, Croci AT, Vicente JRN. Social profile and cost analysis of deep infection following total hip replacement surgery. Rev Bras Ortop 2017; 52 (06) 720-724
• 7 Abdelaziz H, von Förster G, Kühn KD, Gehrke T, Citak M. Minimum 5 years' follow-up after gentamicin- and clindamycin-loaded PMMA cement in total joint arthroplasty. J Med Microbiol 2019; 68 (03) 475-479
• 8 Hansen EN, Adeli B, Kenyon R, Parvizi J. Routine use of antibiotic laden bone cement for primary total knee arthroplasty: impact on infecting microbial patterns and resistance profiles. J Arthroplasty 2014; 29 (06) 1123-1127
• 9 Fleischman AN, Austin MS. Local Intra-wound Administration of Powdered Antibiotics in Orthopaedic Surgery. J Bone Jt Infect 2017; 2 (01) 23-28
• 10 Chiu FY, Chen CM, Lin CF, Lo WH. Cefuroxime-impregnated cement in primary total knee arthroplasty: a prospective, randomized study of three hundred and forty knees. J Bone Joint Surg Am 2002; 84 (05) 759-762
• 11 Chen AF, Fleischman A, Austin MS. Use of Intrawound Antibiotics in Orthopaedic Surgery. J Am Acad Orthop Surg 2018; 26 (17) e371-e378
• 12 McLaren AC, Nugent M, Economopoulos K, Kaul H, Vernon BL, McLemore R. Hand-mixed and premixed antibiotic-loaded bone cement have similar homogeneity. Clin Orthop Relat Res 2009; 467 (07) 1693-1698
• 13 Sanz-Ruiz P, Matas-Diez JA, Sanchez-Somolinos M, Villanueva-Martinez M, Vaquero-Martín J. Is the Commercial Antibiotic-Loaded Bone Cement Useful in Prophylaxis and Cost Saving After Knee and Hip Joint Arthroplasty? The Transatlantic Paradox. J Arthroplasty 2017; 32 (04) 1095-1099
• 14 King JD, Hamilton DH, Jacobs CA, Duncan ST. The Hidden Cost of Commercial Antibiotic-Loaded Bone Cement: A Systematic Review of Clinical Results and Cost Implications Following Total Knee Arthroplasty. J Arthroplasty 2018; 33 (12) 3789-3792
• 15 Parvizi J, Zmistowski B, Berbari EF. et al. New definition for periprosthetic joint infection: from the Workgroup of the Musculoskeletal Infection Society. Clin Orthop Relat Res 2011; 469 (11) 2992-2994
• 16 Parvizi J, Della Valle CJ. AAOS Clinical Practice Guideline: diagnosis and treatment of periprosthetic joint infections of the hip and knee. J Am Acad Orthop Surg 2010; 18 (12) 771-772
• 17 Kurtz SM, Ong KL, Lau E, Bozic KJ, Berry D, Parvizi J. Prosthetic joint infection risk after TKA in the Medicare population. Clin Orthop Relat Res 2010; 468 (01) 52-56
• 18 Gandhi R, Razak F, Pathy R, Davey JR, Syed K, Mahomed NN. Antibiotic bone cement and the incidence of deep infection after total knee arthroplasty. J Arthroplasty 2009; 24 (07) 1015-1018
• 19 Namba RS, Inacio MC, Paxton EW. Risk factors associated with deep surgical site infections after primary total knee arthroplasty: an analysis of 56,216 knees. J Bone Joint Surg Am 2013; 95 (09) 775-782
• 20 Chiu FY, Lin CF, Chen CM, Lo WH, Chaung TY. Cefuroxime-impregnated cement at primary total knee arthroplasty in diabetes mellitus. A prospective, randomised study. J Bone Joint Surg Br 2001; 83 (05) 691-695
• 21 Namba RS, Chen Y, Paxton EW, Slipchenko T, Fithian DC. Outcomes of routine use of antibiotic-loaded cement in primary total knee arthroplasty. J Arthroplasty 2009; 24 (6 Suppl): 44-47
• 22 Wang J, Zhu C, Cheng T. et al. A systematic review and meta-analysis of antibiotic-impregnated bone cement use in primary total hip or knee arthroplasty. PLoS One 2013; 8 (12) e82745
• 23 Dowsey MM, Choong PF. Obese diabetic patients are at substantial risk for deep infection after primary TKA. Clin Orthop Relat Res 2009; 467 (06) 1577-1581
• 24 Jämsen E, Nevalainen P, Eskelinen A, Huotari K, Kalliovalkama J, Moilanen T. Obesity, diabetes, and preoperative hyperglycemia as predictors of periprosthetic joint infection: a single-center analysis of 7181 primary hip and knee replacements for osteoarthritis. J Bone Joint Surg Am 2012; 94 (14) e101
• 25 Cross MB, Yi PH, Thomas CF, Garcia J, Della Valle CJ. Evaluation of malnutrition in orthopaedic surgery. J Am Acad Orthop Surg 2014; 22 (03) 193-199
• 26 Rezapoor M, Parvizi J. Prevention of periprosthetic joint infection. J Arthroplasty 2015; 30 (06) 902-907
• 27 Waitzberg DL, Caiaffa WT, Correia MI. Hospital malnutrition: the Brazilian national survey (IBRANUTRI): a study of 4000 patients. Nutrition 2001; 17 (7-8): 573-580
• 28 Kim S, Bishop AR, Squire MW, Rose WE, Ploeg HL. Mechanical, elution, and antibacterial properties of simplex bone cement loaded with vancomycin. J Mech Behav Biomed Mater 2020; 103: 103588
• 29 Cram P, Lu X, Kates SL, Singh JA, Li Y, Wolf BR. Total knee arthroplasty volume, utilization, and outcomes among Medicare beneficiaries, 1991-2010. JAMA 2012; 308 (12) 1227-1236
• 30 Parvizi J, Tan TL, Goswami K. et al. The 2018 Definition of Periprosthetic Hip and Knee Infection: An Evidence-Based and Validated Criteria. J Arthroplasty 2018; 33 (05) 1309-131 4.e2
• 31 Dal-Paz K, Oliveira PR, Paula AP, Emerick MC, Pécora JR, Lima AL. Economic impact of treatment for surgical site infections in cases of total knee arthroplasty in a tertiary public hospital in Brazil. Braz J Infect Dis 2010; 14 (04) 356-359