Journal of clinical orthopaedics and trauma · 2026
The safety of a very high-dose antibiotic spacer protocol in two-stage revision hip arthroplasty: A retrospective cohort study.
СтатьяНазвание и аннотация: Перевод в очереди
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Santos Alexandra, Tchouambou Youmbi Cheikh, Wolfstadt Jesse I, Gross Allan E, Kuzyk Paul, Safir Oleg, Ekhtiari Seper
Аннотация
BACKGROUND: A common treatment strategy for PJI following THA is a two-stage revision THA, which includes a temporary antibiotic cement spacer (ACS). There are no standard guidelines on the safe and effective dose of antibiotics that can be added to an ACS. Thus, the aim of this study was to evaluate, using a self-controlled design, the safety profile of a very high-dose ACS, particularly as it related to renal function.
METHODS: All patients treated with a completed two-stage revision THA for PJI at a single center between 2004 and 2023 were included. Patients were treated using an ACS with a mean 8 g of antibiotics per bag of medium viscosity cement. The primary outcome was the difference in creatinine rise between the first and second stage, for each patient. Secondary outcomes included the proportion of patients experiencing acute kidney injury (AKI), and the cure rate of PJI treatment. Patients served as their own controls from the first to second stage, with creatinine rise compared between the two stages using a repeated measures analysis of variance (ANOVA).
RESULTS: A total of 68 patients were included. The repeated measures ANOVA revealed no significant within-patient differences between the first- and second-stage creatinine values. The overall incidence of AKI was 1.5% (1/68), with the only case coming after a 1st first-stage procedure. The single patient who developed AKI had a history of diabetes mellitus and experienced transient renal dysfunction, returning to baseline renal function within two weeks.
CONCLUSIONS: The key finding of this study is that a very high-dose ACS is a safe option for patients undergoing two-stage revision for THA PJI with a very high-dose ACS are not at an elevated risk of AKI, and that the impact on kidney function is similar between the first and second stage procedures.
METHODS: All patients treated with a completed two-stage revision THA for PJI at a single center between 2004 and 2023 were included. Patients were treated using an ACS with a mean 8 g of antibiotics per bag of medium viscosity cement. The primary outcome was the difference in creatinine rise between the first and second stage, for each patient. Secondary outcomes included the proportion of patients experiencing acute kidney injury (AKI), and the cure rate of PJI treatment. Patients served as their own controls from the first to second stage, with creatinine rise compared between the two stages using a repeated measures analysis of variance (ANOVA).
RESULTS: A total of 68 patients were included. The repeated measures ANOVA revealed no significant within-patient differences between the first- and second-stage creatinine values. The overall incidence of AKI was 1.5% (1/68), with the only case coming after a 1st first-stage procedure. The single patient who developed AKI had a history of diabetes mellitus and experienced transient renal dysfunction, returning to baseline renal function within two weeks.
CONCLUSIONS: The key finding of this study is that a very high-dose ACS is a safe option for patients undergoing two-stage revision for THA PJI with a very high-dose ACS are not at an elevated risk of AKI, and that the impact on kidney function is similar between the first and second stage procedures.