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Acute renal failure after total hip replacement.

M L Gelman, C H Frazier, H P Chandler

    The Journal of Bone and Joint Surgery. American Volume
    |July 1, 1979
    PubMed
    Summary
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    To prevent postoperative renal failure in total hip replacement patients, avoid combining frozen blood transfusions with nephrotoxic antibiotics. This combination was linked to acute kidney injury in a recent study.

    Area of Science:

    • Nephrology
    • Transfusion Medicine
    • Surgical Patient Care

    Background:

    • Acute renal failure is a potential complication following major orthopedic surgery.
    • The use of blood products and topical antibiotics during surgery may influence postoperative renal outcomes.

    Purpose of the Study:

    • To investigate the association between perioperative interventions and postoperative acute renal failure in total hip replacement (THR) patients.
    • To identify specific agents or combinations that may contribute to renal injury.

    Main Methods:

    • A retrospective analysis of 41 THR patients who received frozen blood, albumin, and bacitracin-neomycin-polymyxin irrigation.
    • A prospective comparison with 55 THR patients who received albumin but not frozen blood or the antibiotic irrigant.

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  • Monitoring for postoperative acute renal failure and relative hypotension in both groups.

    • Main Results:

    • Eight out of 41 patients (19.5%) in the initial group developed acute renal failure.
    • The incidence of hypotension was similar between the two groups.
    • None of the 55 patients in the second group experienced renal failure.

    Conclusions:

    • The combination of frozen blood transfusions and topical nephrotoxic antibiotics (bacitracin-neomycin-polymyxin) is associated with a significant risk of acute renal failure after total hip replacement.
    • Albumin transfusion alone, without frozen blood or the specific antibiotic irrigant, did not lead to renal failure in this patient population.
    • Avoiding the concurrent use of frozen blood and nephrotoxic irrigating solutions is recommended to mitigate the risk of postoperative renal complications in THR surgery.