Tobramycin-impregnated bone cement is frequently used in revision procedures of infected total hip and knee arthroplasties. Aminoglycoside-impregnated cement is typically fashioned into beads or block spacers, which are temporarily placed in infected joint spaces. The use of aminoglycoside-impregnated bone cement has allowed the local concentration to exceed the minimum inhibitory concentration breakpoint of susceptible organisms while serum concentrations after 48 hours were usually not detected. Nephrotoxic complications are rarely encountered with this type of antibiotic delivery method. However, we report the case of an 85-year-old man with a history of renal insufficiency who experienced acute renal failure after undergoing revision treatment of an infected knee arthroplasty with the combined use of tobramycin-cefazolin bone cement and a block spacer. Clinicians should be aware of the potential for aminoglycoside-induced nephrotoxicity from the use of this combination.