Infected primary knee arthroplasty: Risk factors for
               surgical treatment failure

Pradella, João Gabriel Duarte Paes; Bovo, Miguel; Salles, Mauro José Costa; Klautau, Giselle Burlamaqui; Camargo, Osmar Arbix Pedro de; Cury, Ricardo de Paula Leite

doi:10.1016/j.rboe.2012.10.006

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Revista Brasileira de Ortopedia

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Original Articles • Rev. bras. ortop. 48 (05) • Sept-Oct 2013 • https://doi.org/10.1016/j.rboe.2012.10.006 copy

Infected primary knee arthroplasty: Risk factors for surgical treatment failure

Authorship SCIMAGO INSTITUTIONS RANKINGS

OBJECTIVE:

To present epidemiological data and risk factors associated with surgical out-comes 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.

Knee arthroplasty Humans; Bacterial infections/diagnosis; Bacterial infections/therapy

Types of cultures identified	N	%
Staphylococcus aureus	15	31.25
Pseudomonas aeruginosa	11	22.92
Coagulase-negative Staphylococcus	7	14.58
Enterobacter sp.	5	10.41
Streptococcus pyogenes	4	8.33
Escherichia coli	2	4.16
Corynebacterium sp.	1	2.1
Stenotrophomonas maltophilia	1	2.1
Enterococcus sp.	1	2.1
Proteus mirabilis	1	2.1
Total	48	100.0

Types of comorbidity	N	%
Arterial hypertension	31	54.4
Diabetes	9	15.8
Rheumatoid arthritis	2	3.5
Smoking	2	3.5
Stroke	1	1.8
Arrhythmia	1	1.8
Corticoid use	1	1.8
Alcohol abuse	1	1.8
Liver disease	1	1.8
Heart failure	1	1.8
Obesity	1	1.8
Liver transplantation	1	1.8
Total	55	100.0

Characteristics		Result						Total		p-Value^a		Odds ratio
			Therapeutic			Therapeutic		N = 39	(%)			Estimate	95% CI^c
		success N = 22				failure N = 17
				(%)		(%)
Age
	41-59 years	3	(60.0)		2	(40.00)	5		12.8	0.927	(ref)^b
	60-69 years	7	(58.33)		5	(41.67)	12		30.8		1.1		0.1	-	9
	70-79 years	10		(58.82)	7	(41.18)	17		43.6		1		0.1	-	8
	80-89 years	2	(40.0)		3	(60.00)	5		12.8		2.2		0.2	-	28.3
Sex
	Female	20		(60.60)	13 (39.40)		33		84.6	0.374	(ref)^b
	Male	2	(33.33)		4	(66.67)	6		15.4		3.1		0.5	-	19.3
Diagnosis
	Primary	15		(51.72)	14 (48.28)		29		74.4	0.464	(ref)^b
	Secondary	7	(70.0)		3	(30.0)	10		25.6		0.5		0.1	-	2.1
Time
	Early	8	(36.36)		14 (63.64)		22		56.4	0.016^*	14		1.5	-	133.2
	Intermediate	8	(88.89)		1	(11.11)	9		23.1		(ref)^b
	Late	6	(75.00)		2	(25.00)	8		20.5		2.7		0.2	-	36.8
Number of comorbidities
	0	3	(50.00)		3	(50.00)	6		15.4	0.738	(ref)^b
	1	14		(60.87)	9	(39.13)	23		59		0.6		0.1	-	3.9
	2 or more	5	(50.00)		5	(50.00)	10		25.6		1		0.1	-	7.6
Hypertension
	No	5	(62.5)		3	(37.5)	8		20.5	1	(ref)^b
	Yes	17		(54.83)	14 (45.17)		31		79.5		1.4		0.3	-	6.8
Diabetic
	No	20		(62.5)	12 (37.5)		32		82.1	0.206	(ref)^b
	Yes	2	(28.57)		5	(71.43)	7		18		4.2		0.7	-	24.9
	Total	22		(56.41)	17 (43.59)		39		100

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] Corresponding author at: Rua Barata Ribeiro, 380, 6° andar São Paulo, SP, Brazil. CEP 01308-000. Tel.: +11 3214-5334 E-mail: ricacury@uol.com.br (R.d.P.L. Cury).