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DOI: 10.1055/s-0041-1729941
Infecção após artroplastia total primária de joelho: estudo randomizado prospectivo controlado da adição de antibiótico ao cimento ósseo[*]
Artikel in mehreren Sprachen: português | English![](https://www.thieme-connect.de/media/10.1055-s-00042410/202105/lookinside/thumbnails/10-1055-s-0041-1729941_200265_pt-1.jpg)
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
© 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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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