Renal Toxicity Associated With Resection and Spacer Insertion for Chronic Hip PJI

Louis Dagneaux, Afton K. Limberg, Douglas R. Osmon, Nelson Leung, Daniel J. Berry, Matthew P. Abdel

Research output: Contribution to journalArticlepeer-review


Background: Two-stage exchange arthroplasty with high-dose antibiotic-loaded bone cement spacer and intravenous (IV) antibiotics is the most common method of managing infected total hip arthroplasties. However, the contemporary incidence, risk factors, and outcomes of acute kidney injuries (AKIs) in this cohort are unknown. Methods: We identified 227 patients treated with 256 antibiotic-loaded bone cement spacers after resection of an infected primary total hip arthroplasty between 2000 and 2017. Mean age was 65 years, mean body mass index was 30 mg/kg2, 55% were men, and 16% had pre-existing chronic kidney disease (CKD). Spacers were in situ for a mean of 15 weeks, concomitantly associated with IV or oral antibiotics for a mean of 6 weeks. AKI was defined as a creatinine ≥1.5X baseline or ≥0.3 mg/dL. Mean follow-up was 8 years. Results: AKI occurred in 13 patients without pre-existing CKD (7%) vs 10 patients with CKD (28%; OR 5; P = .0001). None required acute dialysis. Postoperative fluid depletion (β = 0.31; P = .0001), ICU requirement (β = 0.40; P = .0001), and acute atrial fibrillation (β = 0.43; P = .0001) were independent predictors for AKI in patients without pre-existing CKD. Duration of in situ spacer, mean antibiotic dose in cement, use of amphotericin B, and type of IV antibiotics were not significant risk factors. At last follow-up, 8 AKIs progressed to CKD, with one receiving dialysis 7 years later. Conclusion: AKIs occurred in 7% of patients with normal renal function, with 5-fold greater risk in those with CKD, and 4% did develop CKD. Importantly, causes of acute renal blood flow impairment were independent predictors for AKI. Level of Evidence: Level III, comparative study.

Original languageEnglish (US)
Pages (from-to)3289-3293
Number of pages5
JournalJournal of Arthroplasty
Issue number9
StatePublished - Sep 2021


  • acute kidney disease
  • antibiotics
  • chronic kidney disease
  • dialysis
  • periprosthetic joint infections

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine


Dive into the research topics of 'Renal Toxicity Associated With Resection and Spacer Insertion for Chronic Hip PJI'. Together they form a unique fingerprint.

Cite this