title: Two-stage arthroplasty for prosthetic joint infection: a systematic review of acute kidney injury, systemic toxicity and infection control.
abstract: Periprosthetic infections of hip and knee joints are now treated by two-stage revision arthroplasty with an infection control rate of 91%. The present systematic review studied the reported incidence of acute kidney injury (AKI) and infection recurrence from January 1989 to June 2012 to assess the risk-benefit ratio of antibiotic spacer use. Ten observational studies (n=544 patients) with clinical outcomes showed an average incidence of AKI of 4.8%. The average reported persistence or recurrence rate of infection was 11% during a follow-up period that ranged from 13 to 108 months. The risk-benefit ratio presently favors treatment although there appears to be higher complication rates and incidence of AKI than previously reported. Marked heterogeneity in practice and lack of detail in reporting precluded more robust quantitative synthesis. Clinicians need to be aware of the potential risk of AKI, particularly in high-risk patients; practice patterns for the use of antibiotic spacers need to be standardized.
authors.affiliation: Tufts University School of Medicine, Boston, MA, USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Luu
authors.forename: Fahd
authors.initials: F
authors.lastname: Syed
authors.forename: Gowri
authors.initials: G
authors.lastname: Raman
authors.forename: Anshul
authors.initials: A
authors.lastname: Bhalla
authors.forename: Eavan
authors.initials: E
authors.lastname: Muldoon
authors.forename: Susan
authors.initials: S
authors.lastname: Hadley
authors.forename: Eric
authors.initials: E
authors.lastname: Smith
authors.forename: Madhumathi
authors.initials: M
authors.lastname: Rao
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology* / Q000209:etiology; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000009:adverse effects; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D005260:Female; D006801:Humans; D015994:Incidence; D007595:Joint Prosthesis / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000188:drug therapy / Q000209:etiology / Q000601:surgery*; D012008:Recurrence; D018570:Risk Assessment; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents
keywords: acute kidney injury; aminoglycoside; arthroplasty; bone cement; hip; knee; prosthesis-related infections