Yash Chaudhry DO³, Mark LaGreca DO³, Hunter Hayes DO³, Efstratios Papadelis DO³, ¹Rao S, ²Amin R
¹Rush University Medical Center, Chicago, IL, USA; ²University of California San Francisco Fresno, Fresno, CA, USA; ³PCOM

INTRODUCTION
The most common cause of revision arthroplasty is prosthetic joint infection (PJI). Chronic PJI is commonly treated with two-stage exchange arthroplasty, which involves the placement of an antibiotic-laden cement spacer (ACS) in the first stage, often containing nephrotoxic antibiotics, such as vancomycin and tobramycin. Many patients with chronic PJI often have significant medical comorbidity burdens, and can cause acute kidney injury (AKI) which is associated with increased mortality risk. This systematic review aims to assess the current literature to identify the incidence of AKI following the first-stage of exchange arthroplasty and associated risk factors.

METHODS
An electronic search was performed of the PubMed database from inception to 1/21/2022 of all studies involving patients undergoing ACS placement for chronic PJI. Studies assessing AKI rates and risk factors were screened by two authors independently; relevant studies were included for review. Data synthesis was performed when possible. Significant heterogeneity of included studies prevented meta-analysis.

RESULTS
Eight observational studies consisting of 540 knee PJIs and 943 hip PJIs met the inclusion criteria for this review. There were 309 (21%) cases involving postoperative AKI. The most commonly reported associated risk factors included perfusion-related factors (lower preoperative hemoglobin, perioperative transfusion requirement or hypovolemia), older age, increased comorbidity burden, and perioperative non-steroidal anti-inflammatory drug consumption. Two studies found increased risk with greater ACS antibiotic concentration (>4g vancomycin and >4.8g tobramycin per spacer in one study, >3.6g of vancomycin per batch or >3.6g of aminoglycosides per batch in the other).

CONCLUSIONS
Patients undergoing ACS placement for chronic PJI are at an increased risk for AKI. Knowing and minimizing risk factors preoperatively can lead to better multidisciplinary care and safer outcomes for chronic PJI patients.