Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania.
Department of Orthopaedic Surgery, Boston University Medical Center, Boston, Massachusetts.
J Arthroplasty. 2024 Feb;39(2):549-558.e3. doi: 10.1016/j.arth.2023.08.055. Epub 2023 Aug 26.
The use of antibiotic-impregnated cement during 2-stage revision arthroplasty for periprosthetic joint infection poses a risk of renal complications following spacer insertion. This systematic review aimed to investigate the rate of acute kidney injury (AKI) following antibiotic-loaded spacer insertion and to identify risk factors associated with this complication.
A systematic review was performed using PubMed, Cochrane Central, and Scopus databases. All clinical studies that documented renal complications following antibiotic-loaded spacer insertion for periprosthetic knee (total knee arthroplasty [TKA]) or hip (total hip arthroplasty [THA]) infection were included. Articles that combined THA and TKA outcomes were also included and labeled "THA + TKA." Descriptive statistics were analyzed when data were available.
There were 24 studies (9 THA, 7 TKA, 8 THA + TKA) included. The mean incidences of spacer-related AKI across THA, TKA, and THA + TKA cohorts were 4.2 (range, 0 to 10%), 14 (range, 0 to 19%), and 27% (range, 0 to 35%), respectively. The most common patient-related risk factors for AKI were underlying chronic kidney disease or high baseline creatinine, low preoperative hemoglobin, and blood transfusion requirement. Spacer-related risk factors included high antibiotic dosage (>3.6 g/cement batch) and antibiotic type. While most recovered without complication, select patients required hemodialysis for acute management (2 THA, 18 THA + TKA) and/or developed chronic kidney disease (8 TKA, 8 THA).
The rate of AKI following spacer insertion was high and likely under-reported in the literature. Surgeons should be cognizant of this devastating complication and should closely monitor at-risk patients for AKI following antibiotic-loaded spacer insertion.
在两阶段翻修关节成形术治疗人工关节周围感染时使用抗生素浸渍水泥会增加 spacer 插入后发生肾脏并发症的风险。本系统评价旨在研究抗生素载药 spacer 插入后发生急性肾损伤 (AKI) 的发生率，并确定与该并发症相关的危险因素。
通过 PubMed、Cochrane Central 和 Scopus 数据库进行系统评价。所有记录了抗生素载药 spacer 插入治疗人工膝关节（全膝关节置换术[TKA]）或髋关节（全髋关节置换术[THA]）感染后肾脏并发症的临床研究均被纳入。同时还纳入了将 THA 和 TKA 结果相结合的文章，并标记为“THA+TKA”。当有数据时，进行描述性统计分析。
共纳入 24 项研究（9 项 THA、7 项 TKA、8 项 THA+TKA）。THA、TKA 和 THA+TKA 队列中 spacer 相关 AKI 的发生率分别为 4.2%（范围，0 至 10%）、14%（范围，0 至 19%）和 27%（范围，0 至 35%）。AKI 的最常见患者相关危险因素包括基础慢性肾脏病或基线肌酐升高、低术前血红蛋白和输血需求。与 spacer 相关的危险因素包括高抗生素剂量（>3.6 g/水泥剂）和抗生素类型。虽然大多数患者没有并发症恢复，但少数患者需要血液透析进行急性治疗（2 例 THA、18 例 THA+TKA）和/或发展为慢性肾脏病（8 例 TKA、8 例 THA）。
spacer 插入后 AKI 的发生率较高，且在文献中可能报告不足。外科医生应意识到这种严重的并发症，并应密切监测在接受抗生素载药 spacer 插入的高危患者发生 AKI 的情况。
