Infection After Primary Total Knee Arthroplasty: A Randomized Controlled Prospective Study of the Addition of Antibiotics to Bone Cement<sup/>

Cobra, Hugo Alexandre de Araujo Barros; Paula Mozella, Alan de; Labronici, Pedro José; Cavalcanti, Amanda S.; Guimarães, João Antonio Matheus

doi:10.1055/s-0041-1729941

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Sumário

Original Article • Rev. bras. ortop. 56 (5) • Nov-Dec 2021 • https://doi.org/10.1055/s-0041-1729941 copy

Infection After Primary Total Knee Arthroplasty: A Randomized Controlled Prospective Study of the Addition of Antibiotics to Bone Cement^* * Study developed at the Instituto Nacional de Traumatologia e Ortopedia (INTO), Rio de Janeiro, RJ, Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

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

	ATB group (n = 128)					No ATB group (n = 158)					p-value
	Median	IQR		Min.	Max.	Median	IQR		Min.	Max.	p-value
Age (years old)	680	61.0	73.0	33.0	83.0	66.0	61.0	72.3	30.0	82.0	0.429^a a Mann-Whitney nonparametric test
BMI (kg/m²)	30.4	26.8	32.6	15.0	43.8	29.3	25.7	33.2	18.0	44.9	0.597^a a Mann-Whitney nonparametric test
Globulin (g/dL)	2.8	2.2	3.2	0.4	4.5	2.7	2.1	3.3	0.06	5.5	0.566^b
Albumin (g/dL)	3.5	3.2	4.0	1.9	7.1	3.6	3.3	3.9	2.2	6.9	0.555^a a Mann-Whitney nonparametric test
Duration of surgery (minutes)	90.0	78.0	105.5	40.0	150	85.0	72.0	100.0	46.0	147.0	0.087^a a Mann-Whitney nonparametric test

	ATB (n = 128)	No ATB (n = 158)	p-value
Gender
Male	21.8% (28/128)	15.8% (25/158)	0.221^a a Fisher’s Exact Test
Female	78.1% (100/128)	84.1% (133/158)	0.221^a a Fisher’s Exact Test
ASA
1	6.2% (8/128)	5.1% (8/158)	0.348^b b Chi-Squared Test.
2	92.2% (118/128)	90.5% (143/158)
3	2.3% (3/128)	3.2% (5/158)
Diagnosis
Osteoarthritis	78.9% (101/128)	70.2% (111/158)	0.911^b b Chi-Squared Test.
Rheumatoid arthritis	19.5% (25/128)	15.2% (24/158)
Other	1.6% (2/128)	1.3% (2/158)
Comorbidities
Diabetes mellitus	2.3% (3/128)	1.9% (3/158)	0.653^a a Fisher’s Exact Test
Systemic arterial hypertension	57.8% (74/128)	59.5 (94/158)
Both	18.0% (23/128)	20.3% (32/158)
No	21.9% (28/128)	18.4% (29/158)

Patient	Group	Time to diagnosis of infection (days)	Microorganism
1	No ATB	915	MRSA
2	No ATB	449	MSSA
3	No ATB	29	Escherichia Coli
4	No ATB	27	MRSA
5	ATB	46	MSSA
6	ATB	39	Mirabilis

Sociedade Brasileira de Ortopedia e Traumatologia Al. Lorena, 427 14º andar, 01424-000 São Paulo - SP - Brasil, Tel.: 55 11 2137-5400 - São Paulo - SP - Brazil
E-mail: rbo@sbot.org.br

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[1] Address for correspondence Hugo Alexandre de Araujo Barros Cobra, Praia do Flamengo, 66, sala 1313, Flamengo, Rio de Janeiro, RJ, 22210-030, Brasil (e-mail: hmcobra@uol.com.br).

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Infection After Primary Total Knee Arthroplasty: A Randomized Controlled Prospective Study of the Addition of Antibiotics to Bone Cement* * Study developed at the Instituto Nacional de Traumatologia e Ortopedia (INTO), Rio de Janeiro, RJ, Brazil.

Abstract

Objective

Methods

Results

Conclusion

Infection After Primary Total Knee Arthroplasty: A Randomized Controlled Prospective Study of the Addition of Antibiotics to Bone Cement^* * Study developed at the Instituto Nacional de Traumatologia e Ortopedia (INTO), Rio de Janeiro, RJ, Brazil.