Elsevier

The Journal of Arthroplasty

Volume 33, Issue 10, October 2018, Pages 3297-3303
The Journal of Arthroplasty

Complications - Other
Acute Kidney Injury Following Failed Total Hip and Knee Arthroplasty

https://doi.org/10.1016/j.arth.2018.06.019Get rights and content

Abstract

Background

Acute kidney injury (AKI) can complicate primary total joint arthroplasty (TJA) of the hip and knee, although the incidence of AKI following revision TJA including prosthetic joint infection (PJI) is poorly defined. We assessed the incidence and risk factors for AKI following revision TJA including surgical treatment of PJI with placement of an antibiotic-loaded cement (ALC) spacer.

Methods

We retrospectively reviewed 3218 consecutive failed TJAs. Patients with aseptic failure were compared to those with PJI. AKI was determined by RIFLE creatinine criteria. PJIs treated with placement of ALC were compared to PJIs without. Risk factors for AKI were determined by multivariable analysis within the whole group and within those with PJI.

Results

AKI developed in 3.4% of 2147 patients revised for aseptic reasons and in 45% of 281 with PJI, including 29% of 197 receiving an ALC and 82% of 84 patients treated with other procedures. By multivariable analysis, age, surgery for PJI, total number of surgeries, and estimated GFR 60-90 compared to >90 cc/min/1.73 m2 were significantly associated with AKI in the whole cohort. Among PJI patients, age, Charlson comorbidity index, and reimplantation surgery were associated with AKI by multivariable analysis. No differences were found between patients with PJI treated with or without ALC. No modifiable factors were found.

Conclusion

AKI develops following aseptic revision TJA at a rate similar to primary TJA, but at a significantly higher rate following surgery for PJI with or without placement of ALC.

Section snippets

Methods

We retrospectively collected data on consecutive patients who underwent surgery (revision TJA or otherwise) for failed primary TJA of the hip or knee at our institution between January 2000 and May 2013. A PJI was defined using criteria proposed by Musculoskeletal Infection Society criteria [12], [13] which include one of the following: 2 positive periprosthetic cultures with phenotypically identical organisms, a sinus tract communicated with the joint, or 3 positive minor criteria. The 3 minor

Results

A total of 3129 consecutive patients with failed primary TJAs underwent revision TJAs or other surgeries at our hospital between January 1, 2000, and May 31, 2013, including 2848 patients with revisions for aseptic reasons and 281 patients with development of PJI. Characteristics at the time of surgery are compared between these 2 groups in Table 2. Patients with PJI more often had TKA as opposed to THA (the original TJA of 59% of patients with PJI involved the knee vs 33% of patients with

Discussion

In an evaluation of 3129 consecutive, failed lower-extremity TJAs, patients with failure for PJI were significantly older, more obese, sicker, had more comorbidity (DM, HTN, CAD), and more often had knees replaced (vs hips) compared to patients with failure and revision for aseptic reasons. Regarding AKI, we found a relatively low incidence of 3.4% in the 2848 patients revised for aseptic reasons, but a significantly higher rate of 45% in the 281 patients treated for PJI. The rate was extremely

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    One or more of the authors of this paper have disclosed potential or pertinent conflicts of interest, which may include receipt of payment, either direct or indirect, institutional support, or association with an entity in the biomedical field which may be perceived to have potential conflict of interest with this work. For full disclosure statements refer to https://doi.org/10.1016/j.arth.2018.06.019.

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