RENAL DYSFUNCTION AFTER TOTAL KNEE REPLACEMENT IS NOT AGGRAVATED BY BONE-CEMENT

Background: Total knee replacement (TKR) has been associated with post operative renal dysfunction. The use of monomeric methylmethacrylate ( MMA) bone cement causes hypotension by several mechanisms. Methods: In 30 patients undergoing TKR with (n=16), or without (n=14) bone cement , serum levels of creatinine, cystatin C and creatine kinase (CK) and urinary levels of creatinine and markers for glomerular (albumin, IgG) and tubular (protein HC) function were recorded preoperatively and on days 1, 2, 4 and 8 postoperatively. Results: There were no changes in serum creatinine. Both groups had a transient, 5-fold rise in CK and a continuous increase in cystatin C. The urinary concentration of prot eins increased postoperatively with a peak in the glomerular markers o n day 1 and in the tubular marker on day 2. There were no significant differences in proteinuria between the groups. The 95% CIs for the dif ference in the means of the AUCs of the logarithmically transformed va lues for the proteins were never more than 19%. On day 8 all proteins had returned to their pre-operative levels. Conclusion: Postoperativel y, there was a transient increased leakage of proteins, indicating glo merular and tubular dysfunction. This was not influenced by the use of MMA bone cement.