J Arthroplasty. 2023 Aug 25:S0883-5403(23)00865-3. doi: 10.1016/j.arth.2023.08.055. Online ahead of print.
ABSTRACT
BACKGROUND: The use of antibiotic-impregnated cement during two-stage revision arthroplasty for periprosthetic joint infection poses a risk of renal complications following spacer insertion. This systematic review aimed to investigate the rate of acute kidney injury (AKI) following antibiotic-loaded spacer insertion and to identify risk factors associated with this complication.
METHODS: A systematic review was performed using PubMed, Cochrane Central, and Scopus databases. All clinical studies that documented renal complications following antibiotic-loaded spacer insertion for periprosthetic knee (TKA) or hip (THA) infection were included. Articles that combined THA and TKA outcomes were also included and labeled ‘THA+TKA.’ Descriptive statistics were analyzed when data were available.
RESULTS: There were 24 studies (9 THA, 7 TKA, 8 THA+TKA) included. Mean incidences of spacer-related AKI across THA, TKA, and THA+TKA cohorts were 4.2 (range, 0 to 10%), 14 (range, 0 to 19%), and 27% (range, 0 to 35%), respectively. The most common patient-related risk factors for AKI were underlying CKD or high baseline creatinine, low preoperative hemoglobin, and blood transfusion requirement. Spacer-related risk factors included high antibiotic dosage (>3.6 g/cement batch) and antibiotic type. While most recovered without complication, select patients required hemodialysis for acute management (2 THA, 18 THA+TKA) and/or developed chronic kidney disease (CKD) (8 TKA, 8 THA).
CONCLUSION: The rate of AKI following spacer insertion was high and likely under-reported in the literature. Surgeons should be cognizant of this devastating complication and should closely monitor at-risk patients for AKI following antibiotic-loaded spacer insertion.
PMID:37634877 | DOI:10.1016/j.arth.2023.08.055
