Infected primary knee arthroplasty: Risk factors for surgical treatment failure

doi:10.1016/j.rboe.2012.10.006

. 2013 Oct 18;48(5):432-437.

doi: 10.1016/j.rboe.2012.10.006. eCollection 2013 Sep-Oct.

Infected primary knee arthroplasty: Risk factors for surgical treatment failure

João Gabriel Duarte Paes Pradella¹, Miguel Bovo¹, Mauro José Costa Salles², Giselle Burlamaqui Klautau³, Osmar Arbix Pedro de Camargo⁴, Ricardo de Paula Leite Cury⁵

Affiliations

¹ Resident Physician in the Department of Orthopedics and Traumatology, School of Medical Sciences, Santa Casa de Misericórdia de São Paulo (DOT-FCMSCP), São Paulo, SP, Brazil.
² PhD in Medicine; Adjunct Professor of Infectology, FCMSCP; Coordinator of the Infectology Clinic, Santa Casa de São Paulo, São Paulo, SP, Brazil.
³ Assistant Professor of Infectology, FCMSCP, São Paulo, SP, Brazil.
⁴ Adjunct Professor, Academic Consultant and Member of the Knee Surgery Group, DOT-FCMSCP, São Paulo, SP, Brazil.
⁵ Lecturer and Head of the Knee Surgery Group, DOT-FCMSCP, São Paulo, SP, Brazil.

PMID: 31304148
PMCID: PMC6565953
DOI: 10.1016/j.rboe.2012.10.006

Infected primary knee arthroplasty: Risk factors for surgical treatment failure

João Gabriel Duarte Paes Pradella et al. Rev Bras Ortop. 2013.

. 2013 Oct 18;48(5):432-437.

doi: 10.1016/j.rboe.2012.10.006. eCollection 2013 Sep-Oct.

Authors

João Gabriel Duarte Paes Pradella¹, Miguel Bovo¹, Mauro José Costa Salles², Giselle Burlamaqui Klautau³, Osmar Arbix Pedro de Camargo⁴, Ricardo de Paula Leite Cury⁵

Affiliations

¹ Resident Physician in the Department of Orthopedics and Traumatology, School of Medical Sciences, Santa Casa de Misericórdia de São Paulo (DOT-FCMSCP), São Paulo, SP, Brazil.
² PhD in Medicine; Adjunct Professor of Infectology, FCMSCP; Coordinator of the Infectology Clinic, Santa Casa de São Paulo, São Paulo, SP, Brazil.
³ Assistant Professor of Infectology, FCMSCP, São Paulo, SP, Brazil.
⁴ Adjunct Professor, Academic Consultant and Member of the Knee Surgery Group, DOT-FCMSCP, São Paulo, SP, Brazil.
⁵ Lecturer and Head of the Knee Surgery Group, DOT-FCMSCP, São Paulo, SP, Brazil.

PMID: 31304148
PMCID: PMC6565953
DOI: 10.1016/j.rboe.2012.10.006

Abstract
in English, Portuguese

Objective: To present epidemiological data and risk factors associated with surgical outcomes favorable or unfavorable for the treatment of infection in infected total knee arthroplasty.

Methods: We reviewed medical records of 48 patients who underwent treatment of primary total knee arthroplasty for infection between January 1994 and December 2008, in the Orthopedics and Traumatology Department of the Santa Casa de Misericórdia de São Paulo. The variables associated with favorable outcome of surgical treatment (debridement and retention or exchange arthroplasty in two days) or unfavorable (arthrodesis or death) infection.

Results: A total of 39 cases of infection after primary total knee arthroplasty, 22 progressed to 17 for a favorable outcome and unfavorable outcome. Early infections (OR: 14.0, 95% CI 1.5-133.2, p = 0.016) and diabetes (OR: 11.3, 95% CI 1.4-89.3, p = 0.032) were associated with arthrodesis joint and death respectively.

Conclusion: Patients with early infection had a higher risk of developing surgical procedure with unfavorable outcome (arthrodesis) and diabetics had higher odds of death after infection of primary knee arthroplasties.

Objetivo: Apresentar dados epidemiológicos e os fatores de risco associados ao desfecho cirúrgico favorável ou desfavorável para o tratamento da infecção na artroplastia total de joelho infectada.

Metódos: Foram revisados 48 prontuários de pacientes submetidos ao tratamento da artroplastia total primária de joelho por infecção entre janeiro de 1994 e dezembro de 2008 no Serviço de Ortopedia e Traumatologia da Santa Casa de Misericórdia de São Paulo. Foram analisadas as variáveis associadas ao desfecho do tratamento cirúrgico favorável (desbridamento e retenção da artroplastia ou troca em dois tempos) ou desfavorável (artrodeses ou óbito) da infecção.

Resultados: Em 39 casos de infecção pós-artroplastia total primária no joelho, 22 evoluíram para desfecho favorável e 17 para desfecho desfavorável. Infecções precoces (RC: 14,0, IC95% 1,5–133,2, p = 0,016) e diabetes (RC: 11,3, IC95% 1,4–89,3, p = 0,032) foram associadas a artrodese da articulação e ao óbito, respectivamente.

Conclusão: Pacientes com infecção precoce apresentaram maior risco de evoluir para procedimento cirúrgico com desfecho não favorável (artrodese) e os diabéticos apresentaram maior chance de óbito após infecção de artroplastias primárias no joelho.

Keywords: Bacterial infections/diagnosis; Bacterial infections/therapy; Humans; Knee arthroplasty.

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References

1. Choi H.R., von Knoch F., Zurakowski D., Nelson S.B., Malchau H. Can implant retention be recommended for treatment of infected TKA? Clin Orthop Relat Res. 2011;469:961–969. - PMC - PubMed
1. Mulvey T.J., Thornhill T.S. Infected total knee arthroplasty. In: Insall J.N., Scott W.N., editors. Surgery of the knee. Churchill Livingston; New York: 2001. pp. 1875–1895.
1. Ivey F.M., Hicks C.A., Calhoun J.H., Mader J.T. Treatment options for infected knee arthroplasties. Rev. Infect. Dis. 1990;12:468–478. - PubMed
1. Letaif O.B., Frucchi R., D’Elia C.O., Demange M.K., Albuquerque R.F.M., Rezende M.U., Pecora J.R., Hernandez A.J., Camanho G.L. Comparação funcional entre revisão de artroplastia de joelho séptica e asséptica. Acta Ortop Bras. 2009;17:159–161.
1. Leonhardt M.C., D’Elia C.O., Santos A.L.G., Lima A.N.L.M., Pécora J.R., Camanho G.L. Revisão da artroplastia total de joelho em dois tempos: o valor da cultura obtida por biópsia artroscópica. Acta Ortop Bras. 2006;14:226–228.

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[1] Choi H.R., von Knoch F., Zurakowski D., Nelson S.B., Malchau H. Can implant retention be recommended for treatment of infected TKA? Clin Orthop Relat Res. 2011;469:961–969. - PMC - PubMed

[2] Choi H.R., von Knoch F., Zurakowski D., Nelson S.B., Malchau H. Can implant retention be recommended for treatment of infected TKA? Clin Orthop Relat Res. 2011;469:961–969. - PMC - PubMed

[3] Mulvey T.J., Thornhill T.S. Infected total knee arthroplasty. In: Insall J.N., Scott W.N., editors. Surgery of the knee. Churchill Livingston; New York: 2001. pp. 1875–1895.

[4] Mulvey T.J., Thornhill T.S. Infected total knee arthroplasty. In: Insall J.N., Scott W.N., editors. Surgery of the knee. Churchill Livingston; New York: 2001. pp. 1875–1895.

[5] Ivey F.M., Hicks C.A., Calhoun J.H., Mader J.T. Treatment options for infected knee arthroplasties. Rev. Infect. Dis. 1990;12:468–478. - PubMed

[6] Ivey F.M., Hicks C.A., Calhoun J.H., Mader J.T. Treatment options for infected knee arthroplasties. Rev. Infect. Dis. 1990;12:468–478. - PubMed

[7] Letaif O.B., Frucchi R., D’Elia C.O., Demange M.K., Albuquerque R.F.M., Rezende M.U., Pecora J.R., Hernandez A.J., Camanho G.L. Comparação funcional entre revisão de artroplastia de joelho séptica e asséptica. Acta Ortop Bras. 2009;17:159–161.

[8] Letaif O.B., Frucchi R., D’Elia C.O., Demange M.K., Albuquerque R.F.M., Rezende M.U., Pecora J.R., Hernandez A.J., Camanho G.L. Comparação funcional entre revisão de artroplastia de joelho séptica e asséptica. Acta Ortop Bras. 2009;17:159–161.

[9] Leonhardt M.C., D’Elia C.O., Santos A.L.G., Lima A.N.L.M., Pécora J.R., Camanho G.L. Revisão da artroplastia total de joelho em dois tempos: o valor da cultura obtida por biópsia artroscópica. Acta Ortop Bras. 2006;14:226–228.

[10] Leonhardt M.C., D’Elia C.O., Santos A.L.G., Lima A.N.L.M., Pécora J.R., Camanho G.L. Revisão da artroplastia total de joelho em dois tempos: o valor da cultura obtida por biópsia artroscópica. Acta Ortop Bras. 2006;14:226–228.

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Infected primary knee arthroplasty: Risk factors for surgical treatment failure

Affiliations

Infected primary knee arthroplasty: Risk factors for surgical treatment failure

Authors

Affiliations

Abstract
in English, Portuguese

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References

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Abstract in English, Portuguese

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References

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Abstract
in English, Portuguese