Research Progress on Risk Factors for Acute Kidney Injury After Antibiotic-Loaded Bone Cement Spacer Treatment for Periprosthetic Joint Infection.

Periprosthetic joint infection (PJI) is a devastating complication of joint arthroplasty and is commonly treated with two-stage revision. During two-stage revision, the insertion of a temporary antibiotic-loaded bone cement spacer (ALCS) in infected joints exerts a direct and effective anti-infection effect but may increase the risk of developing acute kidney injury (AKI). This article reviews the latest research progress on AKI after ALCS insertion for PJI treatment and discusses the definition, incidence and outcome of AKI. We focused on analyzing the risk factors for AKI in terms of demographic characteristics, comorbidities, medication history, perioperative management, and types and doses of antibiotics in ALCS patients. The results revealed that advanced age, excessive obesity, a history of diabetes mellitus, a history of hypertension, the use of angiotensin-converting enzyme inhibitor (ACEI) or angiotensin-II receptor blocker (ARB) medications, a history of chronic kidney disease (CKD), preoperative anemia or hypoalbuminemia, the use of nonsteroidal anti-inflammatory drugs (NSAIDs), high intraoperative blood loss, insufficient perioperative rehydration, and transfusions significantly increased the incidence of AKI. The associations between the development of AKI and antibiotic type and dosage in ALCS are still unclear. Further exploration is still necessary to help clinicians identify PJI patients with a high risk of AKI early and improve their prognosis.