Acute Kidney Injury Following Failed Total Hip and Knee Arthroplasty

Anju Yadav, Pouya Alijanipour, Colin T. Ackerman, Siddharth Karanth, William J. Hozack, Edward J. Filippone

Research output: Contribution to journalArticlepeer-review

12 Scopus citations


Background: Acute kidney injury (AKI) can complicate primary total joint arthroplasty (TJA) of the hip and knee, although the incidence of AKI following revision TJA including prosthetic joint infection (PJI) is poorly defined. We assessed the incidence and risk factors for AKI following revision TJA including surgical treatment of PJI with placement of an antibiotic-loaded cement (ALC) spacer. Methods: We retrospectively reviewed 3218 consecutive failed TJAs. Patients with aseptic failure were compared to those with PJI. AKI was determined by RIFLE creatinine criteria. PJIs treated with placement of ALC were compared to PJIs without. Risk factors for AKI were determined by multivariable analysis within the whole group and within those with PJI. Results: AKI developed in 3.4% of 2147 patients revised for aseptic reasons and in 45% of 281 with PJI, including 29% of 197 receiving an ALC and 82% of 84 patients treated with other procedures. By multivariable analysis, age, surgery for PJI, total number of surgeries, and estimated GFR 60-90 compared to >90 cc/min/1.73 m 2 were significantly associated with AKI in the whole cohort. Among PJI patients, age, Charlson comorbidity index, and reimplantation surgery were associated with AKI by multivariable analysis. No differences were found between patients with PJI treated with or without ALC. No modifiable factors were found. Conclusion: AKI develops following aseptic revision TJA at a rate similar to primary TJA, but at a significantly higher rate following surgery for PJI with or without placement of ALC.

Original languageEnglish (US)
Pages (from-to)3297-3303
Number of pages7
JournalJournal of Arthroplasty
Issue number10
StatePublished - Oct 2018
Externally publishedYes


  • acute kidney injury
  • antibiotic-laden cement spacer
  • prosthetic joint infection
  • revision arthroplasty
  • total hip arthroplasty
  • total knee arthroplasty

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine


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