ABSTRACT
BACKGROUND: 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. METHODS: 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. RESULTS: 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). CONCLUSION: 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.
Subject(s)
Acute Kidney Injury , Arthritis, Infectious , Arthroplasty, Replacement, Hip , Prosthesis-Related Infections , Renal Insufficiency, Chronic , Humans , Anti-Bacterial Agents , Incidence , Prosthesis-Related Infections/drug therapy , Prosthesis-Related Infections/epidemiology , Prosthesis-Related Infections/etiology , Reoperation/adverse effects , Arthroplasty, Replacement, Hip/adverse effects , Arthritis, Infectious/etiology , Acute Kidney Injury/chemically induced , Acute Kidney Injury/epidemiology , Renal Insufficiency, Chronic/complications , Retrospective StudiesABSTRACT
The sprint to create a viable, implantable heart replacement device started in the 1950s, with current technologies still lacking a permanent solution. Early development of artificial hearts was littered with obstacles related to the power source. A pneumatic driver suggested and developed by NASA aimed to discover a more suitable pressure curve through offering highly manipulable parameters, but also enable automatic regulation of hemodynamics. While improved electric function waveforms were identified, the driver was ultimately abandoned due to minimal clinical applicability and an incomplete understanding of cardiovascular physiology. The opportunity for further waveform studies was simultaneously lost.
