Acute kidney injury after placement of an antibiotic-impregnated cement spacer during revision total knee arthroplasty.
We performed a retrospective cohort study of 84 patients to determine the incidence and predictors of acute kidney injury after antibiotic-impregnated cement spacer (ACS) placement for infected total knee arthroplasties. Acute kidney injury was defined as a more than 50% rise in serum creatinine from a preoperative baseline to a level greater than 1.4 mg/dL within 90 days postoperatively. Total incidence was 17% (n = 14; 95% confidence interval [CI], 10%-26%), and acute kidney injury was significantly associated with ACS tobramycin dose as both a dichotomous variable (>4.8 g; odds ratio, 5.87; 95% CI, 1.43-24.19; P = .01) and linear variable (odds ratio, 1.24 for every 1-g increase; 95% CI, 1.00-1.52; P = .049). Routine monitoring of serum creatinine and measurement of serum aminoglycoside levels in response to a threshold creatinine rise may be warranted after the placement of an aminoglycoside-containing ACS.
Department of Orthopaedic Surgery, Vanderbilt University School of Medicine, MCE South Tower, Nashville, Tennessee 37232-8774, USA.
Travis J
TJ
Menge
John R
JR
Koethe
Cathy A
CA
Jenkins
Patty W
PW
Wright
Andrew A
AA
Shinar
Geraldine G
GG
Miller
Ginger E
GE
Holt
D058186:Acute Kidney Injury / Q000097:blood / Q000139:chemically induced* / Q000453:epidemiology*; D000368:Aged; D000617:Aminoglycosides / Q000009:adverse effects / Q000097:blood / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000009:adverse effects* / Q000627:therapeutic use; D019645:Arthroplasty, Replacement, Knee / Q000295:instrumentation* / Q000379:methods; D001843:Bone Cements / Q000009:adverse effects*; D015331:Cohort Studies; D003404:Creatinine / Q000097:blood; D005260:Female; D006801:Humans; D015994:Incidence; D007668:Kidney / Q000503:physiopathology; D007720:Knee Prosthesis / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000517:prevention & control* / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D014031:Tobramycin / Q000009:adverse effects / Q000627:therapeutic use
D000617:Aminoglycosides; D000900:Anti-Bacterial Agents; D001843:Bone Cements; D003404:Creatinine; D014031:Tobramycin