Antibiotic-related acute kidney injury in patients undergoing elective joint replacement

Bone Joint J. 2014 Mar;96-B(3):395-8. doi: 10.1302/0301-620X.96B3.32745.


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.

Keywords: Acute kidney injury; Antibiotics; Arthroplasty; Cefuroxime; Flucloxacillin; Gentamicin; Total Hip Replacement; Total Knee Replacement.

Publication types

  • Comparative Study

MeSH terms

  • Acute Kidney Injury / chemically induced*
  • Acute Kidney Injury / epidemiology
  • Aged
  • Antibiotic Prophylaxis / adverse effects*
  • Arthroplasty, Replacement, Hip*
  • Arthroplasty, Replacement, Knee*
  • Creatinine / blood
  • Female
  • Floxacillin / adverse effects
  • Gentamicins / adverse effects
  • Glomerular Filtration Rate
  • Humans
  • Male
  • Middle Aged
  • Retrospective Studies
  • Risk
  • Scotland / epidemiology
  • Surgical Wound Infection / prevention & control*
  • Teicoplanin / adverse effects


  • Gentamicins
  • Floxacillin
  • Teicoplanin
  • Creatinine