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European Journal of Orthopaedic Surgery & Traumatology

Published in:

01-04-2015 | Original Article

Mechanical evaluation of hip cement spacer reinforcement with stainless steel Kirschner wires, titanium and carbon rods, and stainless steel mesh

Authors: Nobuhiro Kaku, Tomonori Tabata, Hiroshi Tsumura

Published in: European Journal of Orthopaedic Surgery & Traumatology | Issue 3/2015

Abstract

Introduction

In two-stage treatments for infections after total hip arthroplasty, antibiotic-loaded cement spacers help treat the infection by antibiotic elution and prevent contraction. However, such spacers are weak and may fracture while awaiting replacement, impairing functionality. We evaluated whether a Kirschner wire (K-wire) mounted into the spacer reinforced its strength along with the effects of the reinforcing material, position, and intensity.

Methods

Spacers without reinforcing materials constituted the control group. As reinforcing materials, stainless steel K-wires (diameters 3 and 6 mm), titanium alloy and carbon fibers (diameter 3.175 mm), and stainless steel meshes (inner and outer diameters, 6 and 9 mm, respectively) were inserted into the spacer mold before filling with cement. The spacers complied with ISO 7206-4; a compressive load was applied using a testing machine with a velocity of 25.4 mm/min, and the maximum load was recorded. We used 1–3 K-wires positioned on the medial side, lateral side, neck only, and stem only and tested 3 specimens for each condition.

Results

The control group withstood the highest load. Stainless steel was the strongest material; 3-mm K-wires in the neck and lateral side withstood a higher load. The computed tomography (CT) imaging revealed a cavity between the K-wires and cement. When K-wires were inserted along the whole length, despite cement fractures, continuity was maintained because of the reinforcing materials.

Conclusion

It is difficult to improve the reinforcing strength of spacers using K-wires; however, K-wires prevented dislocation of cement spacer fragments, which can help prevent contraction and facilitate spacer removal during replacement.

Cooper HJ, Della Valle CJ (2013) The two-stage standard in revision total hip replacement. Bone Jt J 95-B(11 Suppl A):84–87CrossRef

Van Diemen MP, Colen S, Dalemans AA, Stuyck J, Mulier M (2013) Two-stage revision of an infected total hip arthroplasty: a follow-up of 136 patients. Hip Int 23(5):445–450CrossRefPubMed

Liu K, Zheng J, Jin Y, Zhao YQ (2014) Application of temporarily functional antibiotic-containing bone cement prosthesis in revision hip arthroplasty. Eur J Orthop Surg Traumatol 24(1):51–55CrossRefPubMedCentralPubMed

Yamamoto K, Miyagawa N, Masaoka T, Katori Y, Shishido T, Imakiire A (2003) Clinical effectiveness of antibiotic-impregnated cement spacers for the treatment of infected implants of the hip joint. J Orthop Sci 8(6):823–828CrossRefPubMed

Leunig M, Chosa E, Speck M, Ganz R (1998) A cement spacer for two-stage revision of infected implants of the hip joint. Int Orthop 22(4):209–214CrossRefPubMedCentralPubMed

Peng KT, Hsu WH, Hsu RW (2010) Improved antibiotic impregnated cement prosthesis for treating deep hip infection: a novel design using hip compression screw. J Arthroplast 25(8):1304–1306CrossRef

Romanò CL, Romanò D, Albisetti A, Meani E (2012) Preformed antibiotic-loaded cement spacers for two-stage revision of infected total hip arthroplasty. Long-term results. Hip Int 22(Suppl 8):S46–S53CrossRef

Fei J, Liu GD, Yu HJ, Zhou YG, Wang Y (2011) Antibiotic-impregnated cement spacer versus antibiotic irrigating metal spacer for infection management after THA. Orthopedics 34(3):172PubMed

Cabrita HB, Croci AT, Camargo OP, Lima AL (2007) Prospective study of the treatment of infected hip arthroplasties with or without the use of an antibiotic-loaded cement spacer. Clin Sao Paulo 62(2):99–108

10.

Jung J, Schmid NV, Kelm J, Schmitt E, Anagnostakos K (2009) Complications after spacer implantation in the treatment of hip joint infections. Int J Med Sci 6(5):265–273CrossRefPubMedCentralPubMed

11.

Anagnostakos K, Freymann C, Schmitt E, Kelm J (2011) Relationship between the McPherson classification and complications after hip spacer implantation. Hip Int 21(4):450–456CrossRef

12.

Durbhakula SM, Czajka J, Fuchs MD, Uhl RL (2004) Spacer endoprosthesis for the treatment of infected total hip arthroplasty. J Arthroplast 19(6):760–767CrossRef

13.

Barrack RL (2002) Rush pin technique for temporary antibiotic-impregnated cement prosthesis for infected total hip arthroplasty. J Arthroplast 17(5):600–603CrossRef

14.

Kent M, Rachha R, Sood M (2010) A technique for the fabrication of a reinforced moulded articulating cement spacer in two-stage revision total hip arthroplasty. Int Orthop 34(7):949–953CrossRefPubMedCentralPubMed

15.

Ben-Lulu O, Farno A, Gross AE, Backstein DJ, Kosashvili Y, Safir OA (2012) A modified cement spacer technique for infected total hip arthroplasties with significant bone loss. J Arthroplast 27(4):613–619CrossRef

16.

Uchiyama K, Takahira N, Fukushima K et al (2013) Two-stage revision total hip arthroplasty for periprosthetic infections using antibiotic-impregnated cement spacers of various types and materials. Sci World J 2013:147248

17.

Richards C, Bell CJ, Viswanathan S, English H, Crawford RW (2010) Use of a cement-loaded Kuntscher nail in first-stage revision hip arthroplasty for massive femoral bone loss secondary to infection: a report of four cases. J Orthop Surg Hong Kong 18(1):107–109PubMed

18.

Rodriguez H, Ziran BH (2007) Temporary antibiotic cement-covered gamma nailspacer for an infected nonunion of the proximal femur. Clin Orthop Relat Res 454:270–274CrossRefPubMed

19.

Dairaku K, Takagi M, Kawaji H, Sasaki K, Ishii M, Ogino T (2009) Antibiotics-impregnated cement spacers in the first step of two-stage revision for infected totally replaced hip joints: report of ten trial cases. J Orthop Sci 14(6):704–710CrossRefPubMed

20.

Peng KT, Kuo LT, Hsu WH, Huang TW, Tsai YH (2011) The effect of endoskeleton on antibiotic impregnated cement spacer for treating deep hip infection. BMC Musculoskelet Disord 12:10CrossRefPubMedCentralPubMed

21.

Magnan B, Regis D, Biscaglia R, Bartolozzi P (2001) Preformed acrylic bone cement spacer loaded with antibiotics: use of two-stage procedure in 10 patients because of infected hips after total replacement. Acta Orthop Scand 72(6):591–594CrossRefPubMed

22.

Pattyn C, De Geest T, Ackerman P, Audenaert E (2011) Preformed gentamicin spacers in two-stage revision hip arthroplasty: functional results and complications. Int Orthop 35(10):1471–1476CrossRefPubMedCentralPubMed

23.

D’Angelo F, Negri L, Binda T, Zatti G, Cherubino P (2011) The use of a preformed spacer in two-stage revision of infected hip arthroplasties. Musculoskelet Surg 95(2):115–120CrossRefPubMed

24.

Fleck EE, Spangehl MJ, Rapuri VR, Beauchamp CP (2011) An articulating antibiotic spacer controls infection and improves pain and function in a degenerative septic hip. Clin Orthop Relat Res 469(11):3055–3064CrossRefPubMedCentralPubMed

25.

Schoellner C, Furderer S, Rompe JD, Eckhardt A (2003) Individual bone cement spacers (IBCS) for septic hip revision-preliminary report. Arch Orthop Trauma Surg 123(5):254–259PubMed

26.

Kummer FJ, Strauss E, Wright K, Kubiak EN, Di Cesare PE (2008) Mechanical evaluation of unipolar hip spacer constructs. Am J Orthop (Belle Mead NJ) 37(10):517–518

27.

Thielen T, Maas S, Zuerbes A, Waldmann D, Anagnostakos K, Kelm J (2009) Development of a reinforced PMMA-based hip spacer adapted to patients’ needs. Med Eng Phys 31(8):930–936CrossRefPubMed

28.

Lewis G, Janna S, Bhattaram A (2005) Influence of the method of blending an antibiotic powder with an acrylic bone cement powder on physical, mechanical, and thermal properties of the cured cement. Biomaterials 26(20):4317–4325CrossRefPubMed

Title: Mechanical evaluation of hip cement spacer reinforcement with stainless steel Kirschner wires, titanium and carbon rods, and stainless steel mesh
Authors: Nobuhiro Kaku
Tomonori Tabata
Hiroshi Tsumura
Publication date: 01-04-2015
Publisher: Springer Paris
Published in: European Journal of Orthopaedic Surgery & Traumatology / Issue 3/2015
Print ISSN: 1633-8065
Electronic ISSN: 1432-1068
DOI: https://doi.org/10.1007/s00590-014-1567-0

At a glance: The STEP trials

Springer Medicine

Mechanical evaluation of hip cement spacer reinforcement with stainless steel Kirschner wires, titanium and carbon rods, and stainless steel mesh

Abstract

Introduction

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusion

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