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Kidney Week

Abstract: TH-PO085

Renal Failure After Knee Arthroplasty and Antibiotic Cement: Role of Dialysis

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

  • Vaitla, Pradeep, University of Mississippi, Jackson, Mississippi, United States
  • Kanduri, Swetha Rani, University of Mississippi, Jackson, Mississippi, United States
  • Acharya, Prakrati C., University of Mississippi Medical Center, Ridgeland, Mississippi, United States
  • Kovvuru, Karthik, University of Mississippi Medical Center, Ridgeland, Mississippi, United States
  • Marathi, Rachana, University of mississippi, Madison, Mississippi, United States
Introduction

Two-step arthroplasty procedures have become the standard of care in the treatment of prosthetic joint infections. Antibiotic spacer placement is associated with renal failure requiring dialysis depending on the type and amount of antibiotics. We present a case of renal failure post-antibiotic cement placement. To our knowledge, our case reports one of the highest serum tobramycin levels post spacer impregnation

Case Description

A 65-year-old female with a history of left knee replacement presented with worsening pain and an inability to extend the knee. Bedside arthrocentesis was consistent with an infected prosthetic left knee. She underwent elective arthroplasty. She had no h/o CKD, DM, HTN. She underwent the first step of revision arthroplasty with successful fusion nail and placement of antibiotic cement. Intraoperatively she sustained hypotensive episodes requiring levophed for a brief period. Post-op she had hypoxic respiratory failure associated secondary to laryngeal swelling and stridor, which resolved with steroids

On postoperative (POD) day 2 nephrology was consulted for oliguric renal failure with a serum creatinine of 3.06 mg/dl (Pre-op creatinine 0.7 mg/dl). Renal failure was speculated to be from nephrotoxic medications and Ischemic acute tubular necrosis. Surgery consisted of placing an antibiotic cement spacer, which contained a total of 12 grams of vancomycin and 15 grams of Tobramycin

Drug levels obtained on POD 3 were 38mcg/ml of Vancomycin and 20 mcg/ml of Tobramycin. Her renal failure continued to worsen with a peak serum creatinine of 4.9 mg/dl, developed anuria. She was started on hemodialysis and received 5 sessions over the next 7 days. Dialysis sessions were extended to 4 hours to achieve drug clearance. POD day15, levels decreased to 6.6 mcg/ml of tobramycin and 18.3 mcg/ml of Vancomycin. She demonstrated renal function recovery with a reduction in Tobramycin levels. With an improvement in the renal function explantation of the antibiotic spacer was not required

Discussion

Arthroplasty procedures with antibiotic cement impregnation are associated with significant AKI with incidence varying from 4.8% - 26%. Early recognition of toxicity and timely hemodialysis sessions may help the recovery of renal function and avoid re-exploration and explanation of prosthetic joints and antibiotic spacers