Acute kidney injury in the context of staged revision arthroplasty and the use of antibiotic-laden cement spacers: a systematic review
Abstract Background The most common cause of revision arthroplasty is prosthetic joint infection (PJI). Chronic PJI is commonly treated with two-stage exchange arthroplasty involving the placement of antibiotic-laden cement spacers (ACS) in the first stage, often containing nephrotoxic antibiotics....
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| Format: | Article |
| Language: | English |
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BMC
2023-05-01
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| Series: | Journal of Orthopaedic Surgery and Research |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13018-023-03809-2 |
| _version_ | 1797827481266290688 |
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| author | Yash P. Chaudhry Mark LaGreca Hunter Hayes Efstratios Papadelis Sandesh S. Rao Raj Amin |
| author_facet | Yash P. Chaudhry Mark LaGreca Hunter Hayes Efstratios Papadelis Sandesh S. Rao Raj Amin |
| author_sort | Yash P. Chaudhry |
| collection | DOAJ |
| description | Abstract Background The most common cause of revision arthroplasty is prosthetic joint infection (PJI). Chronic PJI is commonly treated with two-stage exchange arthroplasty involving the placement of antibiotic-laden cement spacers (ACS) in the first stage, often containing nephrotoxic antibiotics. These patients often have significant comorbidity burdens and have higher rates of acute kidney injury (AKI). This systematic review aims to assess the current literature to identify (1) AKI incidence, (2) associated risk factors, and (3) antibiotic concentration thresholds in ACS that increase AKI risk following first-stage revision arthroplasty. Methods An electronic search was performed of the PubMed database of all studies involving patients undergoing ACS placement for chronic PJI. Studies assessing AKI rates and risk factors were screened by two authors independently. Data synthesis was performed when possible. Significant heterogeneity prevented meta-analysis. Results Eight observational studies consisting of 540 knee PJIs and 943 hip PJIs met inclusion criteria. There were 309 (21%) cases involving AKI. The most commonly reported risk factors included perfusion-related factors (lower preoperative hemoglobin, transfusion requirement, or hypovolemia), older age, increased comorbidity burden, and nonsteroidal anti-inflammatory drug consumption. Only two studies found increased risk with greater ACS antibiotic concentration (> 4 g vancomycin and > 4.8 g tobramycin per spacer in one study, > 3.6 g of vancomycin per batch or > 3.6 g of aminoglycosides per batch in the other); however, these were reported from univariate analyses not accounting for other potential risk factors. Discussion Patients undergoing ACS placement for chronic PJI are at an increased risk for AKI. Understanding the risk factors may lead to better multidisciplinary care and safer outcomes for chronic PJI patients. Level of evidence III. |
| first_indexed | 2024-04-09T12:49:00Z |
| format | Article |
| id | doaj.art-fac8abf286f64f8897672097d84a0fec |
| institution | Directory Open Access Journal |
| issn | 1749-799X |
| language | English |
| last_indexed | 2024-04-09T12:49:00Z |
| publishDate | 2023-05-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Orthopaedic Surgery and Research |
| spelling | doaj.art-fac8abf286f64f8897672097d84a0fec2023-05-14T11:22:38ZengBMCJournal of Orthopaedic Surgery and Research1749-799X2023-05-0118111210.1186/s13018-023-03809-2Acute kidney injury in the context of staged revision arthroplasty and the use of antibiotic-laden cement spacers: a systematic reviewYash P. Chaudhry0Mark LaGreca1Hunter Hayes2Efstratios Papadelis3Sandesh S. Rao4Raj Amin5Department of Orthopaedic Surgery, Philadelphia College of Osteopathic MedicineDepartment of Orthopaedic Surgery, Philadelphia College of Osteopathic MedicineDepartment of Orthopaedic Surgery, Philadelphia College of Osteopathic MedicineDepartment of Orthopaedic Surgery, Philadelphia College of Osteopathic MedicineDepartment of Orthopaedic Surgery, Washington Orthopaedics and Sports MedicineDepartment of Orthopaedic Surgery, University of California San Francisco FresnoAbstract Background The most common cause of revision arthroplasty is prosthetic joint infection (PJI). Chronic PJI is commonly treated with two-stage exchange arthroplasty involving the placement of antibiotic-laden cement spacers (ACS) in the first stage, often containing nephrotoxic antibiotics. These patients often have significant comorbidity burdens and have higher rates of acute kidney injury (AKI). This systematic review aims to assess the current literature to identify (1) AKI incidence, (2) associated risk factors, and (3) antibiotic concentration thresholds in ACS that increase AKI risk following first-stage revision arthroplasty. Methods An electronic search was performed of the PubMed database of all studies involving patients undergoing ACS placement for chronic PJI. Studies assessing AKI rates and risk factors were screened by two authors independently. Data synthesis was performed when possible. Significant heterogeneity prevented meta-analysis. Results Eight observational studies consisting of 540 knee PJIs and 943 hip PJIs met inclusion criteria. There were 309 (21%) cases involving AKI. The most commonly reported risk factors included perfusion-related factors (lower preoperative hemoglobin, transfusion requirement, or hypovolemia), older age, increased comorbidity burden, and nonsteroidal anti-inflammatory drug consumption. Only two studies found increased risk with greater ACS antibiotic concentration (> 4 g vancomycin and > 4.8 g tobramycin per spacer in one study, > 3.6 g of vancomycin per batch or > 3.6 g of aminoglycosides per batch in the other); however, these were reported from univariate analyses not accounting for other potential risk factors. Discussion Patients undergoing ACS placement for chronic PJI are at an increased risk for AKI. Understanding the risk factors may lead to better multidisciplinary care and safer outcomes for chronic PJI patients. Level of evidence III.https://doi.org/10.1186/s13018-023-03809-2Acute kidney injuryProsthetic joint infectionAntibiotic cement spacer |
| spellingShingle | Yash P. Chaudhry Mark LaGreca Hunter Hayes Efstratios Papadelis Sandesh S. Rao Raj Amin Acute kidney injury in the context of staged revision arthroplasty and the use of antibiotic-laden cement spacers: a systematic review Journal of Orthopaedic Surgery and Research Acute kidney injury Prosthetic joint infection Antibiotic cement spacer |
| title | Acute kidney injury in the context of staged revision arthroplasty and the use of antibiotic-laden cement spacers: a systematic review |
| title_full | Acute kidney injury in the context of staged revision arthroplasty and the use of antibiotic-laden cement spacers: a systematic review |
| title_fullStr | Acute kidney injury in the context of staged revision arthroplasty and the use of antibiotic-laden cement spacers: a systematic review |
| title_full_unstemmed | Acute kidney injury in the context of staged revision arthroplasty and the use of antibiotic-laden cement spacers: a systematic review |
| title_short | Acute kidney injury in the context of staged revision arthroplasty and the use of antibiotic-laden cement spacers: a systematic review |
| title_sort | acute kidney injury in the context of staged revision arthroplasty and the use of antibiotic laden cement spacers a systematic review |
| topic | Acute kidney injury Prosthetic joint infection Antibiotic cement spacer |
| url | https://doi.org/10.1186/s13018-023-03809-2 |
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