Periprosthetic joint infection (PJI) is a devastating complication of joint arthroplasty and is commonly treated with two-stage revision. During two-stage revision, the insertion of a temporary antibiotic-loaded bone cement spacer (ALCS) in infected joints exerts a direct and effective anti-infection effect but may increase the risk of developing acute kidney injury (AKI). This article reviews the latest research progress on AKI after ALCS insertion for PJI treatment and discusses the definition, incidence and outcome of AKI. We focused on analyzing the risk factors for AKI in terms of demographic characteristics, comorbidities, medication history, perioperative management, and types and doses of antibiotics in ALCS patients. The results revealed that advanced age, excessive obesity, a history of diabetes mellitus, a history of hypertension, the use of angiotensin-converting enzyme inhibitor (ACEI) or angiotensin-II receptor blocker (ARB) medications, a history of chronic kidney disease (CKD), preoperative anemia or hypoalbuminemia, the use of nonsteroidal anti-inflammatory drugs (NSAIDs), high intraoperative blood loss, insufficient perioperative rehydration, and transfusions significantly increased the incidence of AKI. The associations between the development of AKI and antibiotic type and dosage in ALCS are still unclear. Further exploration is still necessary to help clinicians identify PJI patients with a high risk of AKI early and improve their prognosis.
| [1] |
A. M. Schwartz, K. X. Farley, G. N. Guild, and T. L. Bradbury, “Projections and Epidemiology of Revision Hip and Knee Arthroplasty in the United States to 2030,” Journal of Arthroplasty 35 (2020): S79–S85, https://doi.org/10.1016/j.arth.2020.02.030.
|
| [2] |
B. H. Kapadia, R. A. Berg, J. A. Daley, J. Fritz, A. Bhave, and M. A. Mont, “Periprosthetic Joint Infection,” Lancet 387 (2016): 386–394, https://doi.org/10.1016/S0140-6736(14)61798-0.
|
| [3] |
V. Rajput, R. M. D. Meek, and F. S. Haddad, “Periprosthetic Joint Infection: What Next?,” Bone & Joint Journal 104-B (2022): 1193–1195, https://doi.org/10.1302/0301-620X.104B11.BJJ-2022-0944.
|
| [4] |
M. P. Abdel, P. Barreira, A. Battenberg, et al., “Hip and Knee Section, Treatment, Two-Stage Exchange Spacer-Related: Proceedings of International Consensus on Orthopedic Infections,” Journal of Arthroplasty 34 (2019): S427–S438, https://doi.org/10.1016/j.arth.2018.09.027.
|
| [5] |
J. Parvizi, B. Adeli, B. Zmistowski, C. Restrepo, and A. S. Greenwald, “Management of Periprosthetic Joint Infection: The Current Knowledge: AAOS Exhibit Selection,” Journal of Bone and Joint Surgery. American Volume 94 (2012): e104, https://doi.org/10.2106/JBJS.K.01417.
|
| [6] |
C. Theil, R. F. Riegel, G. Gosheger, J. Schwarze, T. Schmidt-Braekling, and B. Moellenbeck, “Acute Renal Failure After the First Stage of a 2-Stage Exchange for Periprosthetic Joint Infection,” Journal of Arthroplasty 36 (2021): 717–721, https://doi.org/10.1016/j.arth.2020.08.028.
|
| [7] |
Y. P. Chaudhry, M. Lagreca, H. Hayes, E. Papadelis, S. S. Rao, and R. Amin, “Acute Kidney Injury in the Context of Staged Revision Arthroplasty and the Use of Antibiotic-Laden Cement Spacers: A Systematic Review,” Journal of Orthopaedic Surgery and Research 18 (2023): 340, https://doi.org/10.1186/s13018-023-03809-2.
|
| [8] |
T. L. Thomas, P. D. Kothari, C. M. Baker, S. Tarabichi, S. C. Clark, and G. S. Goh, “High Incidence of Acute Kidney Injury Following Antibiotic-Loaded Spacer Insertion for Periprosthetic Joint Infection: An Updated Review of the Literature,” Journal of Arthroplasty 39 (2024): 549–558.e3, https://doi.org/10.1016/j.arth.2023.08.055.
|
| [9] |
L. Dagneaux, A. K. Limberg, D. R. Osmon, N. Leung, D. J. Berry, and M. P. Abdel, “Renal Toxicity Associated With Resection and Spacer Insertion for Chronic Hip PJI,” Journal of Arthroplasty 36 (2021): 3289–3293, https://doi.org/10.1016/j.arth.2021.04.012.
|
| [10] |
L. Dagneaux, A. K. Limberg, D. R. Osmon, N. Leung, D. J. Berry, and M. P. Abdel, “Acute Kidney Injury When Treating Periprosthetic Joint Infections After Total Knee Arthroplasties With Antibiotic-Loaded Spacers: Incidence, Risks, and Outcomes,” Journal of Bone and Joint Surgery. American Volume 103 (2021): 754–760, https://doi.org/10.2106/JBJS.20.01825.
|
| [11] |
Z. Li, C. Xu, and J. Chen, “Articulating Spacers: What Are Available and How to Utilize Them?,” Art 5 (2023): 22, https://doi.org/10.1186/s42836-023-00167-6.
|
| [12] |
A. Luu, F. Syed, G. Raman, et al., “Two-Stage Arthroplasty for Prosthetic Joint Infection: A Systematic Review of Acute Kidney Injury, Systemic Toxicity and Infection Control,” Journal of Arthroplasty 28 (2013): 1490–1498.e1.
|
| [13] |
M. M. Valenzuela, S. M. Odum, W. L. Griffin, B. D. Springer, T. K. Fehring, and J. E. Otero, “High-Dose Antibiotic Cement Spacers Independently Increase the Risk of Acute Kidney Injury in Revision for Periprosthetic Joint Infection: A Prospective Randomized Controlled Clinical Trial,” Journal of Arthroplasty 37 (2022): S321–S326, https://doi.org/10.1016/j.arth.2022.01.060.
|
| [14] |
M. J. Savas, K. F. Gray, B. E. Blackburn, C. E. Pelt, J. M. Gililland, and L. K. Certain, “Association of Acute Kidney Injury With Antibiotic Loaded Cement Used for Treatment of Periprosthetic Joint Infection,” Journal of Arthroplasty 38 (2023): 2704–2709.e1, https://doi.org/10.1016/j.arth.2023.05.061.
|
| [15] |
A. Fraval, Y. Zhou, and J. Parvizi, “Antibiotic-Loaded Cement in Total Joint Arthroplasty: A Comprehensive Review,” Archives of Orthopaedic and Trauma Surgery 144 (2024): 5165–5175, https://doi.org/10.1007/s00402-024-05328-z.
|
| [16] |
E. Finger, L. Giniyani, Y. A. Korshunov, and J. L. Rosenstock, “A Case of Severe Acute Kidney Injury due to an Antibiotic-Loaded Cement Spacer for Infected Knee Arthroplasty,” American Journal of Kidney Diseases 85, no. 3 (2024): 389–392, https://doi.org/10.1053/j.ajkd.2024.07.012.
|
| [17] |
J. J. Borick, S. Balan, P. Lichtenberger, and L. Bjork, “Timely Explantation of Tobramycin-Impregnated Beads and Bone Cement to Avoid Haemodialysis in a Patient With Worsening Renal Failure,” BML Case Reports 15 (2022): e242760, https://doi.org/10.1136/bcr-2021-242760.
|
| [18] |
D. Mazza, C. Calderaro, R. Iorio, P. Drogo, V. Andreozzi, and A. Ferretti, “Acute Kidney Failure After Total Knee Arthroplasty Revision With Antibiotic-Impregnated Cement Spacer,” Orthopedic Reviews (Pavia) 12 (2020): 8540, https://doi.org/10.4081/or.2020.8540.
|
| [19] |
S. A. Salim, J. Everitt, A. Schwartz, et al., “Aminoglycoside Impregnated Cement Spacer Precipitating Acute Kidney Injury Requiring Hemodialysis,” Seminars in Dialysis 31 (2018): 88–93, https://doi.org/10.1111/sdi.12639.
|
| [20] |
A. James and T. Larson, “Acute Renal Failure After High-Dose Antibiotic Bone Cement: Case Report and Review of the Literature,” Renal Failure 37 (2015): 1061–1066, https://doi.org/10.3109/0886022X.2015.1052949.
|
| [21] |
S. Dovas, V. Liakopoulos, L. Papatheodorou, et al., “Acute Renal Failure After Antibiotic-Impregnated Bone Cement Treatment of an Infected Total Knee Arthroplasty,” Clinical Nephrology 69 (2008): 207–212.
|
| [22] |
J. M. Curtis, V. Sternhagen, and D. Batts, “Acute Renal Failure After Placement of Tobramycin-Impregnated Bone Cement in an Infected Total Knee Arthroplasty,” Pharmacotherapy 25 (2005): 876–880.
|
| [23] |
T. M. Van Raaij, L. E. Visser, A. G. Vulto, and J. N. Verhaar, “Acute Renal Failure After Local Gentamicin Treatment in an Infected Total Knee Arthroplasty,” Journal of Arthroplasty 17 (2002): 948–950.
|
| [24] |
J. A. Kellum, N. Lameire, P. Aspelin, et al., “Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group. KDIGO Clinical Practice Guideline for Acute Kidney Injury,” Kidney International. Supplement 2 (2012): 1–138, https://doi.org/10.1038/kisup.2012.1.
|
| [25] |
A. Yadav, P. Alijanipour, C. T. Ackerman, S. Karanth, W. J. Hozack, and E. J. Filippone, “Acute Kidney Injury Following Failed Total Hip and Knee Arthroplasty,” Journal of Arthroplasty 33 (2018): 3297–3303, https://doi.org/10.1016/j.arth.2018.06.019.
|
| [26] |
A. I. Edelstein, K. T. Okroj, T. Rogers, C. J. Della Valle, and S. M. Sporer, “Nephrotoxicity After the Treatment of Periprosthetic Joint Infection With Antibiotic-Loaded Cement Spacers,” Journal of Arthroplasty 33 (2018): 2225–2229, https://doi.org/10.1016/j.arth.2018.02.012.
|
| [27] |
J. D. Como, R. Abdulmassih, A. J. Guarascio, et al., “Systemic Absorption Resulting From Tobramycin-Loaded Antibiotic Cement Spacers Used in the Treatment of Prosthetic Joint Infection,” Indian Journal of Orthopaedics 58 (2024): 144–150, https://doi.org/10.1007/s43465-023-01075-2.
|
| [28] |
E. S. Y. Aeng, K. F. Shalansky, T. T. Y. Lau, et al., “Acute Kidney Injury With Tobramycin-Impregnated Bone Cement Spacers in Prosthetic Joint Infections,” Annals of Pharmacotherapy 49 (2015): 1207–1213, https://doi.org/10.1177/1060028015600176.
|
| [29] |
E. E. Reed, J. Johnston, J. Severing, K. B. Stevenson, and M. Deutscher, “Nephrotoxicity Risk Factors and Intravenous Vancomycin Dosing in the Immediate Postoperative Period Following Antibiotic-Impregnated Cement Spacer Placement,” Annals of Pharmacotherapy 48 (2014): 962–969.
|
| [30] |
Z. P. Berliner, A. Z. Mo, D. A. Porter, et al., “In-Hospital Acute Kidney Injury After TKA Revision With Placement of an Antibiotic Cement Spacer,” Journal of Arthroplasty 33 (2018): S209–S212, https://doi.org/10.1016/j.arth.2017.11.050.
|
| [31] |
T. J. Menge, J. R. Koethe, C. A. Jenkins, et al., “Acute Kidney Injury After Placement of an Antibiotic-Impregnated Cement Spacer During Revision Total Knee Arthroplasty,” Journal of Arthroplasty 27 (2012): 1221–1227.e1, https://doi.org/10.1016/j.arth.2011.12.005.
|
| [32] |
Ö. Çağlar, M. Tokgözoğlu, R. C. Akgün, and B. Atilla, “Low-Dose Vancomycin-Loaded Cement Spacer for Two-Stage Revision of Infected Total Hip Arthroplasty,” Joint Diseases and Related Surgery 31 (2020): 449–455, https://doi.org/10.5606/ehc.2020.76108.
|
| [33] |
P.-H. Hsieh, K.-C. Huang, P.-C. Lee, and M. S. Lee, “Two-Stage Revision of Infected Hip Arthroplasty Using an Antibiotic-Loaded Spacer: Retrospective Comparison Between Short-Term and Prolonged Antibiotic Therapy,” Journal of Antimicrobial Chemotherapy 64 (2009): 392–397, https://doi.org/10.1093/jac/dkp177.
|
| [34] |
P.-H. Hsieh, K.-C. Huang, and C.-L. Tai, “Liquid Gentamicin in Bone Cement Spacers: In Vivo Antibiotic Release and Systemic Safety in Two-Stage Revision of Infected Hip Arthroplasty,” Journal of Trauma 66 (2009): 804–808, https://doi.org/10.1097/TA.0b013e31818896cc.
|
| [35] |
K. Anagnostakos, P. Wilmes, E. Schmitt, and J. Kelm, “Elution of Gentamicin and Vancomycin From Polymethylmethacrylate Beads and Hip Spacers In Vivo,” Acta Orthopaedica 80 (2009): 193–197, https://doi.org/10.3109/17453670902884700.
|
| [36] |
E. S. Dedeogullari, O. Caglar, M. Danisman, A. M. Tokgozoglu, S. Kamaci, and B. Atilla, “Low Dose Vancomycin-Loaded Spacers for Two-Stage Revision Knee Arthroplasty: High Success, Low Toxicity,” Knee 40 (2023): 63–70, https://doi.org/10.1016/j.knee.2022.11.008.
|
| [37] |
B. D. Springer, G.-C. Lee, D. Osmon, G. J. Haidukewych, A. D. Hanssen, and D. J. Jacofsky, “Systemic Safety of High-Dose Antibiotic-Loaded Cement Spacers After Resection of an Infected Total Knee Arthroplasty,” Clinical Orthopaedics and Related Research 427 (2004): 47–51, https://doi.org/10.1097/01.blo.0000144476.43661.10.
|
| [38] |
J. A. Geller, G. Cunn, T. Herschmiller, T. Murtaugh, and A. Chen, “Acute Kidney Injury After First-Stage Joint Revision for Infection: Risk Factors and the Impact of Antibiotic Dosing,” Journal of Arthroplasty 32 (2017): 3120–3125, https://doi.org/10.1016/j.arth.2017.04.054.
|
| [39] |
Z. Li, Z. Maimaiti, F. Yang, et al., “Incidence, Associated Factors, and Outcomes of Acute Kidney Injury Following Placement of Antibiotic Bone Cement Spacers in Two-Stage Exchange for Periprosthetic Joint Infection: A Comprehensive Study,” Frontiers in Cellular and Infection Microbiology 13 (2023): 1243290, https://doi.org/10.3389/fcimb.2023.1243290.
|
| [40] |
F. Perschinka, N. Boyer, L. G. Forni, and M. Joannidis, “Renal Function in Very Old Critically Ill Patients,” Current Opinion in Critical Care 29 (2023): 534–541, https://doi.org/10.1097/MCC.0000000000001088.
|
| [41] |
S. G. Coca, “Acute Kidney Injury in Elderly Persons,” American Journal of Kidney Diseases 56 (2010): 122–131, https://doi.org/10.1053/j.ajkd.2009.12.034.
|
| [42] |
L. Xu, Y. Wu, Y. Chen, et al., “Is Acute Kidney Injury Age-Dependent in Older Adults: An Observational Study in Two Centers From North China,” BMC Geriatrics 21 (2021): 7, https://doi.org/10.1186/s12877-020-01906-z.
|
| [43] |
L. Wu, Y. Hu, X. Zhang, et al., “Changing Relative Risk of Clinical Factors for Hospital-Acquired Acute Kidney Injury Across Age Groups: A Retrospective Cohort Study,” BMC Nephrology 21 (2020): 321, https://doi.org/10.1186/s12882-020-01980-w.
|
| [44] |
B. Infante, R. Franzin, D. Madio, et al., “Molecular Mechanisms of AKI in the Elderly: From Animal Models to Therapeutic Intervention,” Journal of Clinical Medicine 9 (2020): 2574, https://doi.org/10.3390/jcm9082574.
|
| [45] |
W. Yang, D. Xie, A. H. Anderson, et al., “Association of Kidney Disease Outcomes With Risk Factors for CKD: Findings From the Chronic Renal Insufficiency Cohort (CRIC) Study,” American Journal of Kidney Diseases 63 (2013): 236–243, https://doi.org/10.1053/j.ajkd.2013.08.028.
|
| [46] |
X. Lin and H. Li, “Obesity: Epidemiology, Pathophysiology, and Therapeutics,” Front Endocrinol (Lausanne) 12 (2021): 706978, https://doi.org/10.3389/fendo.2021.706978.
|
| [47] |
Y. H. Ahn, S. M. Yoon, J. Lee, et al., “Early Sepsis-Associated Acute Kidney Injury and Obesity,” JAMA Network Open 7 (2024): e2354923, https://doi.org/10.1001/jamanetworkopen.2023.54923.
|
| [48] |
J. E. Hall, A. J. Mouton, A. A. Da Silva, et al., “Obesity, Kidney Dysfunction, and Inflammation: Interactions in Hypertension,” Cardiovascular Research 117 (2021): 1859–1876, https://doi.org/10.1093/cvr/cvaa336.
|
| [49] |
J. Danziger, K. P. Chen, J. Lee, et al., “Obesity, Acute Kidney Injury, and Mortality in Critical Illness,” Critical Care Medicine 44 (2016): 328–334, https://doi.org/10.1097/CCM.0000000000001398.
|
| [50] |
Y. Cheng, S. Nie, X. Zhao, et al., “Incidence, Risk Factors and Outcome of Postoperative Acute Kidney Injury in China,” Nephrology, Dialysis, Transplantation 39 (2024): 967–977, https://doi.org/10.1093/ndt/gfad260.
|
| [51] |
J. Neugarten, S. Sandilya, B. Singh, and L. Golestaneh, “Sex and the Risk of AKI Following Cardio-Thoracic Surgery: A Meta-Analysis,” Clinical Journal of the American Society of Nephrology 11 (2016): 2113–2122, https://doi.org/10.2215/CJN.03340316.
|
| [52] |
S. Luthra, L. Viola, M. Navaratnarajah, D. Thirukumaran, and T. Velissaris, “Glycated Haemoglobin (HbA1C) in Cardiac Surgery: A Narrative Review,” Journal of Clinical Medicine 14 (2024): 23, https://doi.org/10.3390/jcm14010023.
|
| [53] |
L.-P. Wu, K. Pang, B. Li, Y. Le, and Y.-Z. Tang, “Predictive Value of Glycosylated Hemoglobin for Post-Operative Acute Kidney Injury in Non-Cardiac Surgery Patients,” Front Med (Lausanne) 9 (2022): 886210, https://doi.org/10.3389/fmed.2022.886210.
|
| [54] |
Y. Gui, Z. Palanza, H. Fu, and D. Zhou, “Acute Kidney Injury in Diabetes Mellitus: Epidemiology, Diagnostic, and Therapeutic Concepts,” FASEB Journal 37 (2023): e22884, https://doi.org/10.1096/fj.202201340RR.
|
| [55] |
L. Qu and B. Jiao, “The Interplay Between Immune and Metabolic Pathways in Kidney Disease,” Cells 12 (2023): 1584, https://doi.org/10.3390/cells12121584.
|
| [56] |
S. Scilletta, M. Di Marco, N. Miano, et al., “Update on Diabetic Kidney Disease (DKD): Focus on Non-Albuminuric DKD and Cardiovascular Risk,” Biomolecules 13 (2023): 752, https://doi.org/10.3390/biom13050752.
|
| [57] |
C. E. Mendez, P. J. Der Mesropian, R. O. Mathew, and B. Slawski, “Hyperglycemia and Acute Kidney Injury During the Perioperative Period,” Current Diabetes Reports 16 (2016): 10, https://doi.org/10.1007/s11892-015-0701-7.
|
| [58] |
A. Advani, “Acute Kidney Injury: A Bona Fide Complication of Diabetes,” Diabetes 69 (2020): 2229–2237, https://doi.org/10.2337/db20-0604.
|
| [59] |
N. Boyer, J. Eldridge, J. R. Prowle, and L. G. Forni, “Postoperative Acute Kidney Injury,” Clinical Journal of the American Society of Nephrology 17 (2022): 1535–1545, https://doi.org/10.2215/CJN.16541221.
|
| [60] |
Z.-Y. Li, Z. Li, C. Xu, et al., “Hypoalbuminemia Is Highly Prevalent in Patients With Periprosthetic Joint Infection and Strongly Associated With Treatment Failure,” Orthopaedic Surgery 16 (2024): 2419–2427, https://doi.org/10.1111/os.14162.
|
| [61] |
Y. Zhu, F. Zhang, W. Chen, S. Liu, Q. Zhang, and Y. Zhang, “Risk Factors for Periprosthetic Joint Infection After Total Joint Arthroplasty: A Systematic Review and Meta-Analysis,” Journal of Hospital Infection 89 (2015): 82–89, https://doi.org/10.1016/j.jhin.2014.10.008.
|
| [62] |
M. Haft, A. R. Agarwal, E. R. Brufsky, et al., “Evaluating the Effect of Decreasing Preoperative Hemoglobin on Blood Transfusions, Major Complications, and Periprosthetic Joint Infection After Primary Total Knee Arthroplasty,” Journal of the American Academy of Orthopaedic Surgeons 32 (2024): 989–996, https://doi.org/10.5435/JAAOS-D-23-01241.
|
| [63] |
M. Greenky, K. Gandhi, L. Pulido, C. Restrepo, and J. Parvizi, “Preoperative Anemia in Total Joint Arthroplasty: Is It Associated With Periprosthetic Joint Infection?,” Clinical Orthopaedics and Related Research 470 (2012): 2695–2701, https://doi.org/10.1007/s11999-012-2435-z.
|
| [64] |
E.-H. Lee, S.-H. Baek, J.-H. Chin, et al., “Preoperative Hypoalbuminemia Is a Major Risk Factor for Acute Kidney Injury Following Off-Pump Coronary Artery Bypass Surgery,” Intensive Care Medicine 38 (2012): 1478–1486, https://doi.org/10.1007/s00134-012-2599-8.
|
| [65] |
K.-H. Shin and S.-B. Han, “Early Postoperative Hypoalbuminemia Is a Risk Factor for Postoperative Acute Kidney Injury Following Hip Fracture Surgery,” Injury 49 (2018): 1572–1576, https://doi.org/10.1016/j.injury.2018.05.001.
|
| [66] |
N. Li, H. Qiao, J.-F. Guo, et al., “Preoperative Hypoalbuminemia Was Associated With Acute Kidney Injury in High-Risk Patients Following Non-Cardiac Surgery: A Retrospective Cohort Study,” BMC Anesthesiology 19 (2019): 171, https://doi.org/10.1186/s12871-019-0842-3.
|
| [67] |
M. Baker and M. A. Perazella, “NSAIDs in CKD: Are They Safe?,” American Journal of Kidney Diseases 76 (2020): 546–557, https://doi.org/10.1053/j.ajkd.2020.03.023.
|
| [68] |
J. M. Laforge, K. Urso, J. M. Day, et al., “Non-Steroidal Anti-Inflammatory Drugs: Clinical Implications, Renal Impairment Risks, and AKI,” Advanced Therapeutics 40 (2023): 2082–2096, https://doi.org/10.1007/s12325-023-02481-6.
|
| [69] |
F. M. De La Vega-Méndez, M. I. Estrada, E. E. Zuno-Reyes, et al., “Blood Transfusion Reactions and Risk of Acute Kidney Injury and Major Adverse Kidney Events,” Journal of Nephrology 37 (2024): 951–960, https://doi.org/10.1007/s40620-023-01859-7.
|
| [70] |
L. S. De Santo, A. S. Rubino, A. P. Montella, et al., “Incidence and Risk Factors of Acute Kidney Injury in Redo Cardiac Surgery: A Single Center Analysis,” Scientific Reports 14 (2024): 27267, https://doi.org/10.1038/s41598-024-78990-3.
|
| [71] |
J. Y. Kim, J. Yee, H. Y. Yoon, J. M. Han, and H. S. Gwak, “Risk Factors for Vancomycin-Associated Acute Kidney Injury: A Systematic Review and Meta-Analysis,” British Journal of Clinical Pharmacology 88 (2022): 3977–3989, https://doi.org/10.1111/bcp.15429.
|
| [72] |
T. A. Le, T. Hiba, D. Chaudhari, et al., “Aminoglycoside-Related Nephrotoxicity and Ototoxicity in Clinical Practice: A Review of Pathophysiological Mechanism and Treatment Options,” Advanced Therapeutics 40 (2023): 1357–1365, https://doi.org/10.1007/s12325-023-02436-x.
|
| [73] |
M. J. Penner, B. A. Masri, and C. P. Duncan, “Elution Characteristics of Vancomycin and Tobramycin Combined in Acrylic Bone-Cement,” Journal of Arthroplasty 11 (1996): 939–944.
|
RIGHTS & PERMISSIONS
2026 The Author(s). Orthopaedic Surgery published by Tianjin Hospital and John Wiley & Sons Australia, Ltd.
PDF
(755KB)
