According to the latest research conducted by Matthew P. Abdel, MD, of the Mayo Clinic in Rochester, Minnesota, and colleagues, patients with chronic kidney disease (CKD) are particularly prone to AKI.
High-dose antibiotics in bone cement are associated with a higher risk of AKI
Deep infection around the prosthesis is a devastating complication of the failure of total knee arthroplasty. The most common treatment is a two-stage arthroplasty, in which knee implants are removed for infection treatment. This is usually followed by the placement of antibiotic-filled bone cement (ALBC) pads, which can deliver high doses of antibiotics directly and continuously to the infection site. Once the infection is eradicated, another surgery will be performed to place a new knee prosthesis.
However, in addition to IV antibiotics, there may be a risk that high-dose antibiotics from the spacer may have toxic effects on the kidneys. This toxicity may lead to AKI: a serious complication characterized by a sudden decline in kidney function. Orthopedics have little evidence of the risk of AKI associated with ALBC spacers and IV antibiotics, or even the long-term prognosis of patients who develop AKI.
Dr. Abdel and colleagues analyzed the incidence, risk factors, and outcomes of AKI in 424 patients with chronic infectious knee arthroplasty who received ALBC spacers and IV antibiotics for two-stage replacement arthroplasty. The patient was treated at the Mayo Clinic from 2000 to 2017. Before surgery, 15% of patients already had CKD.
Overall, 19% of patients developed AKI when using ALBC spacers and intravenous antibiotics. Compared with patients without CKD, patients with CKD are much more likely to develop AKI (45% vs. 14%). After adjusting for other factors, the likelihood of AKI in CKD patients increased five times (odds ratio 5.0).
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