In-Hospital Acute Kidney Injury After TKA Revision With Placement of an Antibiotic Cement Spacer

Berliner, Zachary P.; Mo, Andrew Z.; Porter, David A.; Grossman, Jamie M.; Hepinstall, Matthew S.; Cooper, H. John; Scuderi, Giles R.

doi:10.1016/j.arth.2017.11.050

Cited by 19 publications

(16 citation statements)

References 33 publications

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“…The "gold standard" treatment for chronic PJI involves removing infected implants and inserting a polymethylmethacrylate cement spacer that elutes high concentrations of antibiotics. Unfortunately, these antibiotics are only eluted in pertinent concentrations for 24-48 h after insertion [22,23] and have recently been associated with postoperative renal injury [24,25]. Additionally, bacterial biofilm has been detected on the surface of antibiotic cement spacers at the time of revision surgery [26][27][28].…”

Section: Why Do Contemporary Treatments Fail?mentioning

confidence: 99%

New Innovations in the Treatment of PJI and Biofilms—Clinical and Preclinical Topics

Taha

Abdelbary

Ross

et al. 2018

Curr Rev Musculoskelet Med

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Innovative treatment strategies of bacterial and biofilm infections revolve around (a) augmenting current therapies, such as improving the delivery and efficiency of conventional antibiotics and enhancing the efficacy of antiseptics and (b) administrating completely new therapeutic modalities, such as using immunotherapy, nanoparticles, lytic bacteriophages, photodynamic therapy, novel antibiotics, and antimicrobial peptides. Several promising treatment strategies for PJI are available to be tested further. The next requirement for most of the novel treatments is reproducing their effects in clinically representative animal models of PJI against clinical isolates of relevant bacteria.

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Section: Why Do Contemporary Treatments Fail?mentioning

confidence: 99%

New Innovations in the Treatment of PJI and Biofilms—Clinical and Preclinical Topics

Taha

Abdelbary

Ross

et al. 2018

Curr Rev Musculoskelet Med

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“…Fifty-one articles were identified for full text review, with 8 meeting the criteria for inclusion [ 17 – 24 ] (Table 1 ). Six studies were conducted in the USA [ 18 – 23 ]. The remaining two were conducted in Canada [ 17 ] and Germany [ 24 ].…”

Section: Resultsmentioning

confidence: 99%

“…This included 540 knee revisions and 943 hip revisions. Three studies included only knee revisions [ 18 , 20 , 23 ], one included only hip revisions [ 19 ], and the remaining four had both [ 17 , 21 , 22 , 24 ]. ACS types, quantity of antibiotics added, and systemic antibiotic use are reported in Table 2 .…”

Section: Resultsmentioning

confidence: 99%

Acute kidney injury in the context of staged revision arthroplasty and the use of antibiotic-laden cement spacers: a systematic review

et al. 2023

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Background The most common cause of revision arthroplasty is prosthetic joint infection (PJI). Chronic PJI is commonly treated with two-stage exchange arthroplasty involving the placement of antibiotic-laden cement spacers (ACS) in the first stage, often containing nephrotoxic antibiotics. These patients often have significant comorbidity burdens and have higher rates of acute kidney injury (AKI). This systematic review aims to assess the current literature to identify (1) AKI incidence, (2) associated risk factors, and (3) antibiotic concentration thresholds in ACS that increase AKI risk following first-stage revision arthroplasty. Methods An electronic search was performed of the PubMed database of all studies involving patients undergoing ACS placement for chronic PJI. Studies assessing AKI rates and risk factors were screened by two authors independently. Data synthesis was performed when possible. Significant heterogeneity prevented meta-analysis. Results Eight observational studies consisting of 540 knee PJIs and 943 hip PJIs met inclusion criteria. There were 309 (21%) cases involving AKI. The most commonly reported risk factors included perfusion-related factors (lower preoperative hemoglobin, transfusion requirement, or hypovolemia), older age, increased comorbidity burden, and nonsteroidal anti-inflammatory drug consumption. Only two studies found increased risk with greater ACS antibiotic concentration (> 4 g vancomycin and > 4.8 g tobramycin per spacer in one study, > 3.6 g of vancomycin per batch or > 3.6 g of aminoglycosides per batch in the other); however, these were reported from univariate analyses not accounting for other potential risk factors. Discussion Patients undergoing ACS placement for chronic PJI are at an increased risk for AKI. Understanding the risk factors may lead to better multidisciplinary care and safer outcomes for chronic PJI patients. Level of evidence III.

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“…First, the mechanical properties of current cement spacers are very poor and their use has been associated with joint dislocation, fracture of the construct and major peri-articular bone loss [ 29 ]. Additionally, the elution of antibiotics from the spacers, at concentrations above the Minimum Inhibitory Concentrations (MIC), is very limited in time (72 h) [ 30 ], and, unfortunately, acute postoperative renal injury has been reported during the peak of antibiotic release from the spacer [ 31 ]. Another major limitation of the use of cement spacers is represented by the finding that a bacterial biofilm has been detected on their surfaces at the time of revision surgery [ 32 ].…”

Section: Periprosthetic Joint Infection (Pji) Treatmentmentioning

confidence: 99%

Nanotechnology as an Anti-Infection Strategy in Periprosthetic Joint Infections (PJI)

et al. 2021

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Background: Periprosthetic joint infection (PJI) represents a devastating consequence of total joint arthroplasty (TJA) because of its high morbidity and its high impact on patient quality of life. The lack of standardized preventive and treatment strategies is a major challenge for arthroplasty surgeons. The purpose of this article was to explore the potential and future uses of nanotechnology as a tool for the prevention and treatment of PJI. Methods: Multiple review articles from the PubMed, Scopus and Google Scholar databases were reviewed in order to establish the current efficacy of nanotechnology in PJI preventive or therapeutic scenarios. Results: As a prevention tool, anti-biofilm implants equipped with nanoparticles (silver, silk fibroin, poly nanofibers, nanophase selenium) have shown promising antibacterial functionality. As a therapeutic tool, drug-loaded nanomolecules have been created and a wide variety of carrier materials (chitosan, titanium, calcium phosphate) have shown precise drug targeting and efficient control of drug release. Other nanotechnology-based antibiotic carriers (lipid nanoparticles, silica, clay nanotubes), when added to common bone cements, enhanced prolonged drug delivery, making this technology promising for the creation of antibiotic-added cement joint spacers. Conclusion: Although still in its infancy, nanotechnology has the potential to revolutionize prevention and treatment protocols of PJI. Nevertheless, extensive basic science and clinical research will be needed to investigate the potential toxicities of nanoparticles.

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In-Hospital Acute Kidney Injury After TKA Revision With Placement of an Antibiotic Cement Spacer

Cited by 19 publications

References 33 publications

New Innovations in the Treatment of PJI and Biofilms—Clinical and Preclinical Topics

New Innovations in the Treatment of PJI and Biofilms—Clinical and Preclinical Topics

Acute kidney injury in the context of staged revision arthroplasty and the use of antibiotic-laden cement spacers: a systematic review

Nanotechnology as an Anti-Infection Strategy in Periprosthetic Joint Infections (PJI)

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