Acute Kidney Injury Following Antibiotic Spacer Placement for Two-Stage Arthroplasty

Author(s)

Gregory, S. K.

Author's Affiliation

Abstract

Chronic infection of the joint following total knee arthroplasty is often treated with a two-stage revision process. This involves explantation of the infected hardware and implantation of an antibiotic impregnated cement spacer. Recipes for addition of antibiotics to the cement are variable and can be surgeon specific. Systemic toxicity from the antibiotics can occur but has historically been documented as a rare occurrence. A 71 year old female with a history of total knee replacement developed a case of septic arthritis in the artificial joint following a urinary tract infection. The patient was treated with the first part of two- stage revision including explantation of infected hardware, placement of a tobramycin impregnated spacer, and planned placement of a permanent prosthesis. Following discharge, the patient presented back to the emergency room with acute kidney injury with a significantly elevated tobramycin level (13.4 mcg/ml). The patient required hemodialysis and explantation of the antibiotic spacer before achieving full recovery of baseline renal function. A two-stage revision with implantation of antibiotic laden cement (ALC) is the standard of care for late chronic infection of knee prosthesis. Antibiotic composition of the spacer is variable with no true standard recipe. ALC utilizes much higher doses of antibiotics within the cement than are given intravenously. Traditionally, ALC spacers have been shown to be safe and effective without a high incidence of systemic toxicity.  Despite this notion, systemic toxicity can occur. When high dose aminoglycoside therapy is used, routine renal function monitoring may be considered.

Keywords

Antibiotic Laden Spacer, Tobramycin, Toxicity

Cite This Article

Gregory, S. K. (2014). Acute Kidney Injury Following Antibiotic Spacer Placement for Two-Stage Arthroplasty. International Journal for Pharmaceutical Research Scholars (IJPRS), 3(2), 391-395.