Knee Revision Surgery, Antibiotic Spacers, Led To Acute Kidney Failure: Case Report

A new case report highlights the potential risks associated with knee revision surgery, detailing how a common procedure to remove a failed knee implant and use of antibiotic spacers to fight off infection may have resulted in acute kidney failure for a 65 year old man. 

The problems were outlined in a report published last month in the medical journal Case Reports in Nephrology. Researchers at the University of Illinois at Chicago suggest that the case is an example of a common complication in knee replacement surgery, and highlights the risks associated with this typical two-stage revision treatment.

Researchers detail an incident involving an individual with a history of multiple periprosthetic infections of the left knee, who underwent a revision surgery for the removal of his knee implant, with use of an antibiotic spacer for a period of time.

The surgeons opened the knee, debrided and irrigated the infected cement spacers on the femur and tibia. They then replaced the spacers with a cement mixture of the antibiotics tobramycin and vancomycin. However, two days after the operation, he developed non-oliguric acute kidney injury, which progressed to kidney failure and the need for hemodialysis. Eventually, the antibiotic spacer had to be removed.

“Two-stage revision total knee arthroplasty (TKA) is the standard of care for prosthetic joint infections. The first stage involves removal of the infected prosthesis and placement of an antibiotic impregnated cement spacer; following a period ranging from 4 weeks to 6 months, the spacer is then removed and replaced with a permanent prosthesis,” the researchers wrote. “The advantage to this approach is that antibiotic impregnated spacers provide supratherapeutic levels in the joint without toxic accumulation in serum. However, it remains important for physicians and pharmacists to be aware of antibiotic associated complications in knee revisions.”

The findings come following a study published in April, indicating that three quarters of total knee arthroplasty patients report continuing pain up to six months after surgery. Another study, published in February found that obesity, abnormal bone shapes and bone loss all play a role in catastrophic knee implant failures and the need for revision surgery.

That study found that 26 out of 27 patients who underwent revision surgery had preoperative bone deformities and that the average body mass index of those patients indicated they were severely obese.

While knee replacement surgery is often recommended as a solution for problems experienced with a bad joint, the findings add to increasing concerns in recent years about design problems associated with several widely used implants.

Over the past year, a growing number of individuals have begun evaluating potential knee replacement lawsuits over problems associated with several different types of systems widely used in recent years, which have been linked to high rates of implant failure, resulting in the need for knee revision surgery; including DePuy Attune Knee,Exactech Optetrak Knee, and Arthrex iBalance Knee. Many of the problems with these implants have been linked to tibial loosening and tibial baseplate failures.