A new case report details substantial risk factors from knee revision surgery, highlighting how the procedure to remove a knee implant following failure and the subsequent use of antibiotic spacers to fight off infection may have caused a 65-year-old man to suffer acute kidney failure.
The medical journal Case Reports in Nephrology published the report's findings this past month. University of Illinois at Chicago researchers indicate that this case is just one example of a common knee revision surgery complication, emphasizing the significant risks of this typical two-stage procedure.
Researchers took an in-depth look at an individual’s case, who had a long history of multiple periprosthetic left knee infections. He underwent a revision surgery to remove a failed knee implant. Doctors supplemented the initial surgery with the temporary use of antibiotic spacers to prevent infection.
When surgeons opened his knee, they initially irrigated and debrided the infected cement spacers located on the femur and tibia. Then, the surgery team replaced the contaminated spacers with a cement concoction of tobramycin and vancomycin antibiotics. The patient developed non-oliguric kidney injury within two days of the surgery. The condition quickly advanced to kidney failure, necessitating hemodialysis. Eventually, surgeons had to remove the antibiotic spacer.
“Two-stage revision total knee arthroplasty (TKA) is the standard of care for prosthetic joint infections. The first stage involves removal of the infected prosthesis and placement of an antibiotic impregnated cement spacer; following a period ranging from 4 weeks to 6 months, the spacer is then removed and replaced with a permanent prosthesis,” the researchers wrote. “The advantage to this approach is that antibiotic impregnated spacers provide supratherapeutic levels in the joint without toxic accumulation in serum. However, it remains important for physicians and pharmacists to be aware of antibiotic associated complications in knee revisions.”
Knee Revision Surgery Risk Studies
The case report comes on the heels of another recent knee revision surgery risk study. In April, The Clinical Journal of Pain published a study indicating that three quarters of TKA patients report chronic pain up to six months following surgery.
In February, The Journal of Arthroplasty published research from the OrthoCarolina Hip & Knee Center, suggesting that obesity, abnormal bone structures, and bone loss all contribute to catastrophic knee implant failures. The researchers studied data on 1,106 TKA revision surgeries from 2004 to 2017, focusing on radiographic analysis of 27 cases from their own institute. Researchers found that 26 out of 27 of these patients had preoperative bone deformities. The average body mass index was 38, which indicates severe obesity. Also, 25 out of 27 had radiographic medial tibial bone loss prior to knee implant failure.
Physicians often recommend knee replacement surgery as treatment for bad joint problems. However, these recent findings compound already elevated concerns over significant design problems with several popular knee implants.
A growing number of individuals are stepping forward to take knee implant companies to task for debilitating problems from several different systems that manufacturers have released in recent years. These defective knee replacement systems have unreasonably high failure rates, resulting in necessary knee revision surgery to address problems from the knee implants, including blood poisoning, pseudotumors, and incapacitating pain. Many of these device failures are due to tibial loosening and tibial base plate failures. Recent problematic knee designs include the Exactech Optetrak Knee and Arthrex iBalance Knee among others.