Abstract: SA-PO0343
Tobramycin-Induced AKI Secondary to Antibiotic-Loaded Bone Cement in Aseptic Total Knee Arthroplasty Revision
Session Information
- AKI: Case Reports - Drug/Toxin Injury, Crystals, Obstruction, and Unusual Presentations
October 24, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Albrecht, Sarah, University of California Davis, Davis, California, United States
- Llamas, Marielle, University of California Davis, Davis, California, United States
- Young, Brian Y., University of California Davis, Davis, California, United States
Introduction
Periprosthetic joint infections (PJI) are a severe complication after joint replacement or revision. Perioperative antibiotic loaded bone cement (ALBC) is used to treat PJI as it provides local release of antibiotics, while presumably minimizing systemic exposure. Previous studies reported acute kidney injury (AKI) after total knee arthroplasty revision (TKAr) with use of high dose ALBC for PJI. In this case report, we highlight a patient that underwent aseptic TKAr with prophylactic ALBC who developed AKI with systemically detectable tobramycin levels.
Case Description
An 85-year-old female with a history of L TKA (1999) was admitted for TKAr due to medial instability. Preoperative creatinine was 0.86mg/dl (eGFR 67). There were no signs of infection preoperatively and intraoperatively. A total of 6 batches of ALBC (containing 6g tobramycin and 5g vancomycin) was used to fill the tibial canal, femoral canal, and patella. She received 4g cefazolin. After surgery, there was a steady uptrend in creatinine to a peak of 2.23mg/dl (eGFR 21) on POD4 (Table 1). Review of chart showed an episode of hypotension responsive to fluid resuscitation on POD1. She received additional fluids without improvement in creatinine. Urine studies showed Una <30, Uk 26, and UOsm 249 and granular casts. Renal US was negative for obstruction. A tobramycin trough level was elevated at 2.8 ug/mL on POD4. The creatinine down trended to 1.95mg/dl (eGFR 25) with a tobramycin trough level 1.2 ug/mL on POD6.
Discussion
Current orthopedic guidelines for aseptic TKAr have a moderate recommendation to use ALBC due to a higher risk of PJI. This case used lower dose ALBC which resulted in an uptrending creatinine. Although the tobramycin trough level was 2.8 ug/mL, it is suspected that systemic levels were higher earlier post-op. Close monitoring of tobramycin levels postoperatively is warranted for potential AKI. More investigation is needed to assess the optimal dose for ALBC to mitigate AKI and PJI risk. This case highlights the importance of awareness of kidney complications related to prophylactic ALBC.