High-Dose Antibiotic Cement Spacers Independently Increase the Risk of Acute Kidney Injury in Revision for Periprosthetic Joint Infection: A Prospective Randomized Controlled Clinical Trial

Valenzuela, Michael M.; Odum, Susan M.; Griffin, William L.; Springer, Bryan D.; Fehring, Thomas K.; Otero, Jesse E.

doi:10.1016/j.arth.2022.01.060

Cited by 13 publications

(14 citation statements)

References 36 publications

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“…Sharqzad et al 25 2019 found that 2-stage procedures had significantly greater durations of operation (p = 0.006), more allogenic transfusions (p < 0.001), and greater total blood loss (p < 0.001) than 1-stage revisions. Patients who had 2-stage exchanges were also found to be more likely to develop an acute kidney injury (p = 0.011) 27 .…”

Section: Resultsmentioning

confidence: 98%

“…According to the Newcastle-Ottawa grading scale and AHRQ (Agency for Healthcare Research and Quality) score conversion, 9 articles were considered "good" quality and 6 were considered "fair" quality (Table I). Table II shows all the studies included and the outcome measurements that were reported 7,[12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] . There was heterogeneity between selected studies (I 2 5 31%, p 5 0.12).…”

Section: Reinfection Rates and Success Ratesmentioning

confidence: 99%

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Outcomes of 1-Stage Versus 2-Stage Revisions After Hip Prosthetic Joint Infection

Patel,

Sparks,

Blood

et al. 2023

JBJS Journal of Orthopaedics for Physician Assistants

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Background: Prosthetic joint infections (PJIs) are significant complications of total joint arthroplasties. The incidence of this dangerous complication is expected to rise, but there is not a unanimous solution. Two-stage surgical revisions are the traditional gold standard of treatment, but recent literature suggests that 1-stage revisions can be equally effective. A comparison of the outcomes of 2-stage revisions vs. 1-stage revisions has not been thoroughly investigated. This systematic review and meta-analysis were designed to compare the outcomes of 2-stage exchanges vs. 1-stage exchanges in the treatments of hip PJI based on comparison studies. Methods: MEDLINE, Embase, and Cochrane were searched for relevant studies that compared the effectiveness and outcomes of 1-stage and 2-stage procedures from January 2000 to May 2023. Keywords relating to hip PJI were used, and comparison studies of 1-stage vs. 2-stage procedures that reported patient characteristics and outcomes including success rates, rates of reinfection, or other outcomes such as functional outcomes (e.g., mean Harris hip scores), infection-free survival, and blood loss were included. Statistical analysis for this study was conducted using Review Manager 5.4 with a standard p-value of ≤ 0.05 for statistical significance. Results: Fifteen articles and 1,017 patients were included in the meta-analysis. One-stage revision procedures (320 patients) were found to have greater success rates (i.e., lower rates of reinfection) than 2-stage revisions (697 patients) (p = 0.04). One-stage revisions (184 patients) had shorter durations of operation and less blood loss than 2-stage revisions (90 patients) (p < 0.05). Conclusion: One-stage revision procedures are associated with lower reinfection rates, blood loss, and durations of operation compared with 2-stage revisions. Level of Evidence: I.

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Section: Resultsmentioning

confidence: 98%

Section: Reinfection Rates and Success Ratesmentioning

confidence: 99%

Outcomes of 1-Stage Versus 2-Stage Revisions After Hip Prosthetic Joint Infection

Patel,

Sparks,

Blood

et al. 2023

JBJS Journal of Orthopaedics for Physician Assistants

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“…Patients undergoing successful 2-stage exchange for hip PJI without a further surgical procedure incurred approximately $40,000 less total costs than those requiring further surgical procedures following reimplantation 35 . High-dose antibiotic cement spacers for the treatment of PJI were found to be independent risk factors for acute kidney injury, which had a rate of 22.7% following the first stage of a planned 2-stage exchange versus 6.6% following a 1-stage exchange 36 . A study comparing knee spacer types (new femoral component, cement-on-cement, and static) found no difference in the odds of infection clearance and showed increased range of motion and improved ambulatory status prior to reimplantation utilizing the new-femoral-component spacer design 37 .…”

Section: Surgical Treatmentmentioning

confidence: 99%

“…A prospective, randomized controlled trial demonstrated that the use of an antibiotic spacer with 2 g of vancomycin and 2.4 g of tobramycin per bag of PALACOS cement (Heraeus Medical) in the treatment of PJI is an independent risk factor for acute kidney injury, particularly in patients with chronic kidney disease 36 .…”

Section: Antibiotics and Pjimentioning

confidence: 99%

What’s New in Musculoskeletal Infection

Otero

Brown

Courtney

et al. 2023

Journal of Bone and Joint Surgery

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“…The odds of venous thromboembolism after revision for infection were twice those for aseptic revision, but fracture as an indication for revision was still associated with the highest risk 76 . Finally, a contemporary trial revealed that the placement of an antibiotic-impregnated cement spacer was an independent risk factor for acute kidney injury 77 .…”

Section: Revision Tkamentioning

confidence: 99%

What’s New in Adult Reconstructive Knee Surgery

Villa

Singh

Higuera-Rueda

2022

Journal of Bone and Joint Surgery

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Over the past year, areas of investigation in total knee arthroplasty (TKA) and unicompartmental knee arthroplasty (UKA) such as bleeding control, thromboprophylaxis, pain management, technology-assisted surgery, and infection received major attention. We have included selected studies, many at the highest Levels of Evidence, in an attempt to summarize the most relevant recent findings. Economics of Added TechnologyAhmed et al. 1 evaluated the adoption of computer-assisted knee arthroplasty between the first quarter of 2010 and the third quarter of 2017 in the states of New York and Florida, making use of 2 statewide administrative databases (the Statewide Planning and Research Cooperative System in New York and the Florida Administrative Data in Florida). The proportion of computerassisted knee arthroplasty increased from 4.89% to 9.45% in New York, and from 4.03% to 5.73% in Florida. In New York, that represented a 93.3% growth in utilization. One of the reasons preventing the widespread adoption of these new technologies is their increased costs. In a Markov model, Rajan et al. 2 ascertained the cost-effectiveness of robotic-assisted TKA compared with conventional TKA. Robotic-assisted TKA produced 13.55 qualityadjusted life-years (QALYs) compared with 13.29 QALYs for conventional TKA. Because of its higher QALYs, robotic-assisted TKA remains cost-effective despite being associated with higher costs as long as annualized revision rates stay <1.6%. The costutility of patient-specific instrumentation for TKA compared with the standard of care among patients with a body mass index (BMI) of >30 kg/m 2 was evaluated; patient-specific instrumentation was more costly and less effective 3 . A secondary analysis of a randomized clinical trial (RCT) comparing closed-incision, negative-pressure therapy with the standard of care after revision TKA revealed that the total per-patient costs for surgical-site management were $1,047 for closed-incision, negative-pressure therapy and $2,036 for the standard of care 4 . Knee OsteoarthritisGenetic markers seem to play a role in advanced knee osteoarthritis. Utilizing clinical and genomic data, investigators showed that age and BMI contributed more to the risk of developing end-stage disease than genetic factors. However, 7 genetic loci were significantly associated with end-stage osteoarthritis. The effects of genetic factors were greater in patients who were <60 years of age 5 . The use of hyaluronic acid and platelet-rich plasma remains controversial. Among Medicare patients, hyaluronic acid utilization increased from 1,090,503 patients in 2012 to 1,209,489 patients in 2018 (p = 0.04), and total costs related to hyaluronic acid services increased from $290.10 million to $325.02 million (p < 0.01) 6 . In patients with hemophilic knee arthritis, a trial compared the effects of platelet-rich plasma injections with those of placebo on outcomes over a 24-month follow-up. There were no clinically important differences in the Western Ontario and McMaster Universities Osteoarthritis I...

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High-Dose Antibiotic Cement Spacers Independently Increase the Risk of Acute Kidney Injury in Revision for Periprosthetic Joint Infection: A Prospective Randomized Controlled Clinical Trial

Cited by 13 publications

References 36 publications

Outcomes of 1-Stage Versus 2-Stage Revisions After Hip Prosthetic Joint Infection

Outcomes of 1-Stage Versus 2-Stage Revisions After Hip Prosthetic Joint Infection

What’s New in Musculoskeletal Infection

What’s New in Adult Reconstructive Knee Surgery

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