Acute kidney injury (AKI) with the use of antibiotic-impregnated bone cement in primary total knee arthroplasty.

Dear Editor, Antibiotic-impregnated bone cement has been used routinely in total hip and knee replacements as it has been shown to reduce the incidence of deep wound infection.1-7 The antibiotics used include nephrotoxic gentamicin as well as tobramycin and polymyxin, besides other less nephrotoxic such as cefuroxime. The risk of nephrotoxicity from the use of the former has been deemed to be low, as while high local concentrations of the drug are produced in the vicinity of the implants, serum concentrations are kept at safe low levels.8-10 There have been previous reports of acute kidney injury with use of nephrotoxic antibiotic-impregnated cement in large amounts as spacers, after removal of implants in infected total hip and knee replacements.11-14 We report a patient who developed acute kidney injury (AKI) after primary total knee replacement using gentamicin-impregnated bone cement.