To investigate whether chronic kidney disease (CKD) is associated with the risk of all-cause revision or revision due to a periprosthetic joint infection (PJI) after primary hip or knee arthroplasty. This retrospective cohort study comprised 18,979 consecutive hip and knee arthroplasties from a single high-volume academic hospital. At a median of 5.6 years (interquartile range (IQR) 3.5 to 8.1), all deaths and revisions were counted. To overcome the competing risk of death, competing risk analysis using the cumulative incidence function (CIF) was applied to analyze the association between different stages of CKD and revisions. Confounding factors such as diabetes and BMI were considered using either a stratified CIF or the Fine and Gray model.Aims
Methods
In the absence of an identified organism, single-stage revision is contraindicated in prosthetic joint infection (PJI). However, no studies have examined the use of intra-articular antibiotics in combination with single-stage revision in these cases. In this study, we present the results of single-stage revision using intra-articular antibiotic infusion for treating culture-negative (CN) PJI. A retrospective analysis between 2009 and 2016 included 51 patients with CN PJI who underwent single-stage revision using intra-articular antibiotic infusion; these were compared with 192 culture-positive (CP) patients. CN patients were treated according to a protocol including intravenous vancomycin and a direct intra-articular infusion of imipenem and vancomycin alternately used in the morning and afternoon. In the CP patients, pathogen-sensitive intravenous (IV) antibiotics were administered for a mean of 16 days (12 to 21), and for resistant cases, additional intra-articular antibiotics were used. The infection healing rate, Harris Hip Score (HHS), and Hospital for Special Surgery (HSS) knee score were compared between CN and CP groups.Aims
Methods
The aim of this study was to determine if a change
in antibiotic prophylaxis for routine hip and knee replacement was
associated with an increased risk of acute renal impairment. We identified 238 patients (128 knees and 110 hips) who had received
a single prophylactic dose of 1.5 g cefuroxime before joint replacement.
We compared them with prospectively collected data from 254 patients
(117 knees and 137 hips) who received a single prophylactic dose
of 2 g flucloxacillin and a height- and gender-determined dose of
gentamicin. The primary outcome measure was any new renal impairment
as graded by clinically validated criteria. We identified four patients (1.69%) in the cefuroxime group who
developed renal impairment. All four had mild impairment and all
renal function was normal by the third post-operative day. The incidence
of new-onset renal impairment was significantly higher in the flucloxacillin-and-gentamicin
group at 9.45% (24 patients) (p <
0.001). Three of these patients
remained with acute renal impairment after a week, although the
serum creatinine levels in all subsequently returned to normal. Cite this article:
