Download PDF
CC BY-NC-ND 4.0 · Rev Bras Ortop (Sao Paulo) 2022; 57(02): 193-199
DOI: 10.1055/s-0041-1729936
Artigo de Atualização
Joelho

Infecção periprotética do joelho – Parte 2: Tratamento

Article in several languages: português | English
João Maurício Barretto 
1   Coordenador de Ortopedia da Clínica São Vicente da Gávea, Rede D'or São Luiz, Rio de Janeiro, RJ, Brasil
,
André Luiz Siqueira Campos 
2   Departamento de Ortopedia e Traumatologia, Hospital Federal dos Servidores do Estado, Rio de Janeiro, RJ, Brasil
,
Nelson Hiroyuki Miyabe Ooka 
3   Departamento de Ortopedia e Traumatologia, Hospital Universitário Pedro Ernesto, Rio de Janeiro, RJ, Brasil
4   Departamento de Ortopedia e Traumatologia, Hospital Universitário Clementino Fraga Filho, Rio de Janeiro, RJ, Brasil
› Author Affiliations
› Further Information
   Permissions and Reprints

Resumo

Diversas modalidades de tratamento são propostas para as infecções periprotéticas, com índices de sucesso variáveis. No entanto, a eficácia está relacionada à seleção adequada dos casos para cada tipo de tratamento.

O desbridamento com retenção do implante é indicado em infecções agudas com implante fixo, e seu sucesso depende do tipo de infecção, das comorbidades do hospedeiro e da virulência do agente etiológico.

A revisão em um ou dois estágios se impõem nos casos em que haja formação de biofilme, ou nos quais se tenha afrouxamento do implante. A escolha entre realizar a revisão em um ou dois estágios depende de fatores como identificação do agente etiológico, virulência do patógeno, fatores locais e sistêmicos do hospedeiro.

Os procedimentos de salvamento como artrodese, amputação, artroplastia de ressecção ou, ainda, supressão antibiótica são reservados para os casos em que não se conseguiu erradicação da infecção.

Palavras-chave

artroplastia do joelho - infecção de sítio cirúrgico - tratamento - revisão cirúrgica - antibiótico


Publication History

Received: 06 November 2020

Accepted: 17 December 2020

Article published online:
27 May 2022

© 2022. 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/)

Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

 

  • Referências

  • 1 Argenson JN, Arndt M, Babis G. et al. Hip and Knee Section, Treatment, Debridement and Retention of Implant: Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty 2019; 34 (2S): S399-S419
    CrossrefPubMedGoogle Scholar
  • 2 Osmon DR, Berbari EF, Berendt AR. et al. Infectious Diseases Society of America. Diagnosis and management of prosthetic joint infection: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis 2013; 56 (01) e1-e25
    CrossrefPubMedGoogle Scholar
  • 3 Parvizi J, Gehrke T. Anais do 2o. Encontro do Consenso Internacional (ICM) em Infecção Musculoesqueletica [Internet]. ICM Philly. 2019 [citado 22 de março de 2020]. Disponível em: https://icmphilly.com/document/icm-document-translations/icm-document-portugues-brasil-translation/
    PubMedGoogle Scholar
  • 4 Choo KJ, Austin M, Parvizi J. Irrigation and Debridement, Modular Exchange, and Implant Retention for Acute Periprosthetic Infection After Total Knee Arthroplasty. JBJS Essential Surg Tech 2019; 9 (04) e38
    CrossrefPubMedGoogle Scholar
  • 5 Son WS, Shon OJ, Lee DC, Park SJ, Yang HS. Efficacy of Open Debridement and Polyethylene Exchange in Strictly Selected Patients with Infection after Total Knee Arthroplasty. Knee Surg Relat Res 2017; 29 (03) 172-179
    CrossrefPubMedGoogle Scholar
  • 6 Iza K, Foruria X, Moreta J. et al. DAIR (Debridement, Antibiotics and Implant Retention) less effective in hematogenous total knee arthroplasty infections. J Orthop Surg Res 2019; 14 (01) 278
    CrossrefPubMedGoogle Scholar
  • 7 Wouthuyzen-Bakker M, Sebillotte M, Lomas J. et al. ESCMID Study Group for Implant-Associated Infections (ESGIAI). Clinical outcome and risk factors for failure in late acute prosthetic joint infections treated with debridement and implant retention. J Infect 2019; 78 (01) 40-47
    CrossrefPubMedGoogle Scholar
  • 8 Tornero E, Morata L, Martínez-Pastor JC. et al. KLIC-score for predicting early failure in prosthetic joint infections treated with debridement, implant retention and antibiotics. Clin Microbiol Infect 2015; 21 (08) 786.e9-786.e17
    CrossrefPubMedGoogle Scholar
  • 9 Rajgopal A, Panda I, Rao A, Dahiya V, Gupta H. Does Prior Failed Debridement Compromise the Outcome of Subsequent Two-Stage Revision Done for Periprosthetic Joint Infection Following Total Knee Arthroplasty?. J Arthroplasty 2018; 33 (08) 2588-2594
    CrossrefPubMedGoogle Scholar
  • 10 Lizaur-Utrilla A, Asensio-Pascual A, Gonzalez-Parreño S, Miralles-Muñoz FA, Lopez-Prats FA. Negative impact of prior debridement on functional outcome of subsequent two-stage revision for early knee periprosthetic infection. Knee Surg Sports Traumatol Arthrosc 2019; 27 (07) 2309-2315
    CrossrefPubMedGoogle Scholar
  • 11 Kim K, Zhu M, Cavadino A, Munro JT, Young SW. Failed Debridement and Implant Retention Does Not Compromise the Success of Subsequent Staged Revision in Infected Total Knee Arthroplasty. J Arthroplasty 2019; 34 (06) 1214-1220.e1
    CrossrefPubMedGoogle Scholar
  • 12 Pangaud C, Ollivier M, Argenson JN. Outcome of single-stage versus two-stage exchange for revision knee arthroplasty for chronic periprosthetic infection. EFORT Open Rev 2019; 4 (08) 495-502
    CrossrefPubMedGoogle Scholar
  • 13 Kini SG, Gabr A, Das R, Sukeik M, Haddad FS. Two-stage Revision for Periprosthetic Hip and Knee Joint Infections. Open Orthop J 2016; 10 (Suppl -2, M2): 579-588
    CrossrefPubMedGoogle Scholar
  • 14 Thakrar RR, Horriat S, Kayani B, Haddad FS. Indications for a single-stage exchange arthroplasty for chronic prosthetic joint infection: a systematic review. Bone Joint J 2019; 101-B (1_Supple_A, Suppl A): 19-24
    CrossrefPubMedGoogle Scholar
  • 15 George DA, Konan S, Haddad FS. Single-Stage Hip and Knee Exchange for Periprosthetic Joint Infection. J Arthroplasty 2015; 30 (12) 2264-2270
    CrossrefPubMedGoogle Scholar
  • 16 Lee YS, Chen AF. Two-Stage Reimplantation in Infected Total Knee Arthroplasty. Knee Surg Relat Res 2018; 30 (02) 107-114
    CrossrefPubMedGoogle Scholar
  • 17 Vaishya R, Agarwal AK, Rawat SK, Singh H, Vijay V. Is Single-stage Revision Safe Following Infected Total Knee Arthroplasty? A Critical Review. Cureus 2017; 9 (08) e1629
    PubMedGoogle Scholar
  • 18 Lichstein P, Su S, Hedlund H. et al. Treatment of Periprosthetic Knee Infection With a Two-stage Protocol Using Static Spacers. Clin Orthop Relat Res 2016; 474 (01) 120-125
    CrossrefPubMedGoogle Scholar
  • 19 Negus JJ, Gifford PB, Haddad FS. Single-Stage Revision Arthroplasty for Infection-An Underutilized Treatment Strategy. J Arthroplasty 2017; 32 (07) 2051-2055
    CrossrefPubMedGoogle Scholar
  • 20 Rowan FE, Donaldson MJ, Pietrzak JR, Haddad FS. The Role of One-Stage Exchange for Prosthetic Joint Infection. Curr Rev Musculoskelet Med 2018; 11 (03) 370-379
    CrossrefPubMedGoogle Scholar
  • 21 Haddad FS, Sukeik M, Alazzawi S. Is single-stage revision according to a strict protocol effective in treatment of chronic knee arthroplasty infections?. Clin Orthop Relat Res 2015; 473 (01) 8-14
    CrossrefPubMedGoogle Scholar
  • 22 Zahar A, Kendoff DO, Klatte TO, Gehrke TA. Can Good Infection Control Be Obtained in One-stage Exchange of the Infected TKA to a Rotating Hinge Design? 10-year Results. Clin Orthop Relat Res 2016; 474 (01) 81-87
    CrossrefPubMedGoogle Scholar
  • 23 Bonanzinga T, Tanzi G, Iacono F, Ferrari MC, Marcacci M. Periprosthetic knee infection: two stage revision surgery. Acta Biomed 2017; 88 (4S): 114-119
    PubMedGoogle Scholar
  • 24 Gehrke T, Alijanipour P, Parvizi J. The management of an infected total knee arthroplasty. Bone Joint J 2015; 97-B (10, Suppl A): 20-29
    CrossrefPubMedGoogle Scholar
  • 25 Barton CB, Wang DL, An Q, Brown TS, Callaghan JJ, Otero JE. Two-Stage Exchange Arthroplasty for Periprosthetic Joint Infection Following Total Hip or Knee Arthroplasty Is Associated With High Attrition Rate and Mortality. J Arthroplasty 2019;•••:S0883540319311374
    Google Scholar
  • 26 Abdel MP, Akgün D, Akin G. et al. Hip and Knee Section, Diagnosis, Pathogen Isolation, Culture: Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty 2019; 34 (2S): S361-S367
    CrossrefPubMedGoogle Scholar
  • 27 Ascione T, Barrack R, Benito N. et al. General Assembly, Diagnosis, Pathogen Isolation - Culture Matters: Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty 2019; 34 (2S): S197-S206
    CrossrefPubMedGoogle Scholar
  • 28 Bauer TW, Bedair H, Creech JD. et al. Hip and Knee Section, Diagnosis, Laboratory Tests: Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty 2019; 34 (2S): S351-S359
    CrossrefPubMedGoogle Scholar
  • 29 Aalirezaie A, Abolghasemian M, Busato T. et al. Hip and Knee Section, Treatment, Two-Stage Exchange: Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty 2019; 34 (2S): S439-S443
    CrossrefPubMedGoogle Scholar
  • 30 Aalirezaie A, Bauer TW, Fayaz H. et al. Hip and Knee Section, Diagnosis, Reimplantation: Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty 2019; 34 (2S): S369-S379
    CrossrefPubMedGoogle Scholar
  • 31 Preininger B, Janz V, von Roth P, Trampuz A, Perka CF, Pfitzner T. Inadequacy of Joint Aspiration for Detection of Persistent Periprosthetic Infection During Two-Stage Septic Revision Knee Surgery. Orthopedics 2017; 40 (04) 231-234
    CrossrefPubMedGoogle Scholar
  • 32 Mazzucchelli L, Rosso F, Marmotti A, Bonasia DE, Bruzzone M, Rossi R. The use of spacers (static and mobile) in infection knee arthroplasty. Curr Rev Musculoskelet Med 2015; 8 (04) 373-382
    CrossrefPubMedGoogle Scholar
  • 33 Faschingbauer M, Bieger R, Reichel H, Weiner C, Kappe T. Complications associated with 133 static, antibiotic-laden spacers after TKA. Knee Surg Sports Traumatol Arthrosc 2016; 24 (10) 3096-3099
    CrossrefPubMedGoogle Scholar
  • 34 Drexler M, Dwyer T, Kuzyk PRT. et al. The results of two-stage revision TKA using Ceftazidime-Vancomycin-impregnated cement articulating spacers in Tsukayama Type II periprosthetic joint infections. Knee Surg Sports Traumatol Arthrosc 2016; 24 (10) 3122-3130
    CrossrefPubMedGoogle Scholar
  • 35 Siddiqi A, Nace J, George NE. et al. Primary Total Knee Arthroplasty Implants as Functional Prosthetic Spacers for Definitive Management of Periprosthetic Joint Infection: A Multicenter Study. J Arthroplasty 2019; 34 (12) 3040-3047
    CrossrefPubMedGoogle Scholar
  • 36 Chen YP, Wu CC, Ho WP. Autoclaved metal-on-cement spacer versus static spacer in two-stage revision in periprosthetic knee infection. Indian J Orthop 2016; 50 (02) 146-153
    CrossrefPubMedGoogle Scholar
  • 37 Lu J, Han J, Zhang C, Yang Y, Yao Z. Infection after total knee arthroplasty and its gold standard surgical treatment: Spacers used in two-stage revision arthroplasty. Intractable Rare Dis Res 2017; 6 (04) 256-261
    CrossrefPubMedGoogle Scholar
  • 38 Yu Q, Luo M, Wu S. et al. Comparison of infection eradication rate of using articulating spacers containing bio-inert materials versus all-cement articulating spacers in revision of infected TKA: a systematic review and meta-analysis. Arch Orthop Trauma Surg 2019; 139 (05) 695-707
    CrossrefPubMedGoogle Scholar
  • 39 Romanò CL, Gala L, Logoluso N, Romanò D, Drago L. Two-stage revision of septic knee prosthesis with articulating knee spacers yields better infection eradication rate than one-stage or two-stage revision with static spacers. Knee Surg Sports Traumatol Arthrosc 2012; 20 (12) 2445-2453
    CrossrefPubMedGoogle Scholar
  • 40 Fu J, Ni M, Li H. et al. The proper timing of second-stage revision in treating periprosthetic knee infection: reliable indicators and risk factors. J Orthop Surg Res 2018; 13 (01) 214
    CrossrefPubMedGoogle Scholar
  • 41 Amanatullah D, Dennis D, Oltra EG. et al. Hip and Knee Section, Diagnosis, Definitions: Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty 2019; 34 (2S): S329-S337
    CrossrefPubMedGoogle Scholar
  • 42 de Beaubien B, Belden K, Bell K. et al. Hip and Knee Section, Treatment, Antimicrobials: Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty 2019; 34 (2S): S477-S482
    CrossrefPubMedGoogle Scholar
  • 43 Li H, Ni M, Li X, Zhang Q, Li X, Chen J. Two-stage revisions for culture-negative infected total knee arthroplasties: A five-year outcome in comparison with one-stage and two-stage revisions for culture-positive cases. J Orthop Sci 2017; 22 (02) 306-312
    CrossrefPubMedGoogle Scholar
  • 44 Bialecki J, Bucsi L, Fernando N. et al. Hip and Knee Section, Treatment, One Stage Exchange: Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty 2019; 34 (2S): S421-S426
    CrossrefPubMedGoogle Scholar
  • 45 Capuano N, Logoluso N, Gallazzi E, Drago L, Romanò CL. One-stage exchange with antibacterial hydrogel coated implants provides similar results to two-stage revision, without the coating, for the treatment of peri-prosthetic infection. Knee Surg Sports Traumatol Arthrosc 2018; 26 (11) 3362-3367
    CrossrefPubMedGoogle Scholar
  • 46 Kendoff D, Gehrke T. Surgical management of periprosthetic joint infection: one-stage exchange. J Knee Surg 2014; 27 (04) 273-278
    Article in Thieme ConnectPubMedGoogle Scholar
  • 47 Klatte TO, Kendoff D, Kamath AF. et al. Single-stage revision for fungal peri-prosthetic joint infection: a single-centre experience. Bone Joint J 2014; 96-B (04) 492-496
    CrossrefPubMedGoogle Scholar
  • 48 Citak M, Friedenstab J, Abdelaziz H. et al. Risk Factors for Failure After 1-Stage Exchange Total Knee Arthroplasty in the Management of Periprosthetic Joint Infection. J Bone Joint Surg Am 2019; 101 (12) 1061-1069
    CrossrefPubMedGoogle Scholar
  • 49 Wang HY, Zhang Md R, Luo ZY. et al. One-Stage Arthroplasty or Revision for Seronegative Infections in Hip and Knee. Orthop Surg 2020; 12 (01) 38-49
    CrossrefPubMedGoogle Scholar
  • 50 Ji B, Zhang X, Xu B, Guo W, Mu W, Cao L. Single-Stage Revision for Chronic Fungal Periprosthetic Joint Infection: An Average of 5 Years of Follow-Up. J Arthroplasty 2017; 32 (08) 2523-2530
    CrossrefPubMedGoogle Scholar
  • 51 Holland G, Brown G, Goudie S, Brenkel I, Walmsley PJ. Results of Using a “2-in-1” Single-Stage Revision Total Knee Arthroplasty for Infection with Associated Bone Loss: Prospective 2-Year Follow-Up. J Knee Surg 2021; 34 (05) 526-532
    Article in Thieme ConnectPubMedGoogle Scholar
  • 52 Anemüller R, Belden K, Brause B. et al. Hip and Knee Section, Treatment, Antimicrobials: Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty 2019; 34 (2S): S463-S475
    CrossrefPubMedGoogle Scholar
  • 53 Kunutsor SK, Whitehouse MR, Lenguerrand E, Blom AW, Beswick AD. INFORM Team. Re-Infection Outcomes Following One- And Two-Stage Surgical Revision of Infected Knee Prosthesis: A Systematic Review and Meta-Analysis. PLoS One 2016; 11 (03) e0151537
    CrossrefPubMedGoogle Scholar
  • 54 Lichstein P, Gehrke T, Lombardi A. et al. One-stage vs two-stage exchange. J Arthroplasty 2014; 29 (2, Suppl): 108-111
    CrossrefPubMedGoogle Scholar
  • 55 Troendlin F, Frieler S, Hanusrichter Y, Yilmaz E, Schildhauer TA, Baecker H. Persistent Fistula for Treatment of a Failed Periprosthetic Joint Infection: Relic From the Past or a Viable Salvage Procedure?. J Arthroplasty 2020; 35 (02) 544-549
    CrossrefPubMedGoogle Scholar
  • 56 Mozella AP, Palma IM, Souza AF, Gouget GO, Cobra HA. Amputação após falha ou complicação de artroplastia total de joelho: incidência, etiologia e resultados funcionais. Rev Bras Ortop 2013; 48 (05) 406-411
    CrossrefPubMedGoogle Scholar
  • 57 Warren SI, Murtaugh TS, Lakra A. et al. Treatment of Periprosthetic Knee Infection With Concurrent Rotational Muscle Flap Coverage Is Associated With High Failure Rates. J Arthroplasty 2018; 33 (10) 3263-3267
    CrossrefPubMedGoogle Scholar
  • 58 Matar HE, Stritch P, Emms N. Higher failure rate of two-stage revision for infected knee arthroplasties in significantly compromised (host-C) patients. Knee Surg Sports Traumatol Arthrosc 2019; 27 (07) 2206-2210
    CrossrefPubMedGoogle Scholar
  • 59 Goldman AH, Clark NJ, Taunton MJ, Lewallen DG, Berry DJ, Abdel MP. Definitive Resection Arthroplasty of the Knee: A Surprisingly Viable Treatment to Manage Intractable Infection in Selected Patients. J Arthroplasty 2020; 35 (03) 855-858
    CrossrefPubMedGoogle Scholar