Acute Kidney Injury After Prophylactic Cefuroxime and Gentamicin in Patients Undergoing Primary Hip and Knee Arthroplasty-A Propensity Score-Matched Study.

BACKGROUND: Perioperative acute kidney injury (AKI) can be associated with lower limb arthroplasty and increases morbidity, length of stay, and mortality. AKI is more prevalent in some antibiotic regimes compared with others. The aim of the present study is to assess the impact of cefuroxime (CEF), with or without gentamicin (±G), on AKI rates. METHODS: A prospective cohort study involving patients undergoing hip or knee arthroplasty was performed, between September 1, 2015 and November 30, 2016. Prophylactic intravenous antibiotics were administered according to local policy. AKI was graded according to the validated Acute Kidney Injury Network criteria based on the changes from baseline serum creatinine values. Propensity score matching was performed to identify risk factors. The local audit department approved the study. Appropriate statistical analyses were performed. RESULTS: A total of 2560 met the inclusion criteria, with a female preponderance (1447/2560; 56.5%). The mean age was 67.5 ± 10.7 years, with males being significantly younger (65.9 ± 10.9 vs 68.7 ± 10.4 years). AKI developed in 32 cases (1.25%). There was no difference in AKI rates between CEF alone and CEF in combination with gentamicin (1.07% vs 1.36%; P = .524). Overall 31/32 cases were Acute Kidney Injury Network stage I. AKI did not affect the length of stay. Postoperative infection rate was 7/2560 (0.27%). There were no incidences of Clostridium difficile-associated diarrhea. Multivariate analysis demonstrated an increased AKI risk with the use of intravenous gentamicin. CONCLUSION: C ± G yields low rates of infection and AKI compared with high-dose penicillin-based regimes. It is a safe and effective choice for lower limb arthroplasty.

Unpressurised cement acetabular liner (UCAL)--an additional technique for enhancing hip spacer performance.

First stage revision of an infected hip can be a complex procedure. Effective infection control may dictate leaving a skeletalised hip with bony defects. Decisions must be made to adapt to the intra-operative findings. It is important that the surgeon has many options to deal with the many potential challenges. The ideal spacer preserves the remaining bone stock but also allows articulation, is stable in doing so, delivers antibiotics locally, is resistant to breakage and is easily removed. Current spacer options struggle to achieve all of these goals. The use of an unpressurised cement acetabular liner (UCAL) is an additional option, which bestows a number of advantages. We describe two cases, which illustrate this.