Renal impairment after high doses of dicloxacillin-prophylaxis in joint replacement surgery

The frequency of postoperative renal impairment after total hip and knee replacement was studied prospectively in 350 patients without signs of pre-existing renal disease. The first 278 patients were given dicloxacillin as prophylaxis against infection. In the remaining 72 patients dicloxacillin was excluded and gentamicin-impregnated cement was used as the only infection prophylaxis. In 35 patients in the first group (13 per cent), postoperative serum-creatinine was increased to pathological values. Thirteen of these patients were clinically affected, two had to be dialysed, and one died. In the second group there was no case of renal impairment. It is concluded that the systemic administration of antibiotics may be a cause of postoperative illness due to renal impairment.