1
|
Jaenisch M, Ben Amar S, Babasiz M, Seuser A, Kohlhof H, Wirtz DC, Randau TM. Temporary arthrodesis through static spacer implantation in two-stage treatment of periprosthetic joint infections of the knee. Oper Orthop Traumatol 2023:10.1007/s00064-023-00809-7. [PMID: 37171589 DOI: 10.1007/s00064-023-00809-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 11/19/2022] [Accepted: 12/16/2022] [Indexed: 05/13/2023]
Abstract
OBJECTIVE Treatment of chronic periprosthetic joint infection of the knee requires the removal of the implant and thorough debridement, with reimplantation in a second stage surgery. Intramedullary spacers can be helpful during the interval between explantation and reimplantation and provide a temporary arthrodesis which fixes the knee in extension preserving leg length and administers local antibiotic therapy. INDICATIONS Periprosthetic joint infection of the knee with large bony defects and severe infection of the native joint with advanced destruction/infiltration of the cartilage and bone and/or ligament insufficiency. CONTRAINDICATIONS Suspected antibiotic resistance of the microbiological pathogen to local antibiotic drugs, incompliant patient, and known allergy to bone cement or antibiotic. SURGICAL TECHNIQUE After implant removal, suitable metal rods are coated with antibiotic-loaded bone cement and inserted into the cleaned intramedullary canals of femur and tibia. Rods are joined at the joint line with a connector and joint space is filled with more bone cement to achieve temporary and very stable arthrodesis. POSTOPERATIVE MANAGEMENT Partial weight-bearing and no flexion/extension while spacer is in place; second stage reimplantation as soon as infection is controlled. RESULTS Complications related to the spacer were rare (5.3%). Reimplantation of an implant was possible in 95 of 113 patients (84%), of those, 23 (20%) received an arthrodesis. Of the 95 patients that were reimplanted, 14 showed signs of recurrent infection. Mean time to last follow-up was 15.6 months post reimplantation. Mean knee pain was 2.9/10; overall function was good; 6 patients had an extension lag; mean total range of motion was 88°.
Collapse
Affiliation(s)
- Max Jaenisch
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universiätsklinik Bonn, Venusberg-Campus 1, 53105, Bonn, Germany
| | - Soufian Ben Amar
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universiätsklinik Bonn, Venusberg-Campus 1, 53105, Bonn, Germany
| | - Mari Babasiz
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universiätsklinik Bonn, Venusberg-Campus 1, 53105, Bonn, Germany
| | - Alexander Seuser
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universiätsklinik Bonn, Venusberg-Campus 1, 53105, Bonn, Germany
| | - Hendrik Kohlhof
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universiätsklinik Bonn, Venusberg-Campus 1, 53105, Bonn, Germany
- Abteilung für Unfall‑, Hand- und Orthopädische Chirurgie, St. Antonius-Krankenhaus Köln, Schillerstraße 23, 50968, Cologne, Germany
| | - Dieter Christian Wirtz
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universiätsklinik Bonn, Venusberg-Campus 1, 53105, Bonn, Germany
| | - Thomas Martin Randau
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universiätsklinik Bonn, Venusberg-Campus 1, 53105, Bonn, Germany.
- Klinik für Orthopädie, Spezielle Orthopädische Chirurgie und Sportorthopäde, Krankenhaus der Augustinerinnen, Jakobstr. 27-31, 50678, Köln, Deutschland.
| |
Collapse
|
2
|
Schöbel T, Schleifenbaum S, Nitsch V, Hepp P, Theopold J. Primary stability of cement augmentation in locking plate fixation for proximal humeral fractures: A comparison of absorbable versus non-absorbable cement. Clin Biomech (Bristol, Avon) 2022; 91:105516. [PMID: 34814041 DOI: 10.1016/j.clinbiomech.2021.105516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 10/25/2021] [Accepted: 11/01/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Cement augmentation has been suggested to increase the stability of screw anchoring in osteoporotic humeral fractures. Initial results are promising but may be jeopardized by cement leakage into the joint and difficult implant removal. Absorbable cement might have advantages in this regard, but it is unclear if the primary stability of both techniques is equivalent to each other. Therefore, this study aimed to compare its primary stability with that of non-absorbable cement augmentation. METHODS Nineteen cadaveric humeri with two-part fracture models were treated with locking plate osteosynthesis and cement augmentation using either absorbable calcium phosphate cement (group 1) or polymethylmethacrylate (group 2). Fracture movement, stiffness, failure mode, and ultimate load under cyclic compressive loading were examined and compared between the groups. FINDINGS The absolute and relative stiffness values in group 1 were significantly smaller than those in group 2 after 50 cycles (group 1: 114 ± 38 N/mm and 94 ± 8% vs. group 2: 188 ± 71 N/mm and 106 ± 9%; p50 = 0.022), 2000 cycles (group 1: 97 ± 34 N/mm and 81 ± 15% vs. group 2: 153 ± 47 N/mm and 88 ± 15%; p2000 = 0.028), and 5000 cycles (group 1: 98 ± 40 N/mm and 81 ± 22% vs. group 2: 158 ± 40 N/mm and 92 ± 16%; p5000 = 0.028). The failure load was not statistically significantly different between the groups. INTERPRETATION Although the PMAA group showed higher values for absolute and relative stiffness, no statistically significant difference was found in the primary stability between absorbable and non-absorbable cement augmentation supporting plate osteosynthesis in proximal humeral fractures. In view of the potential advantages of bio-absorbable cement during the healing process, its use should be considered for the augmentation and stabilization of osteoporotic fractures.
Collapse
Affiliation(s)
- Tobias Schöbel
- Department of Orthopedic, Trauma, and Plastic Surgery, University of Leipzig, Liebigstraße 20, 04103 Leipzig, Germany.
| | - Stefan Schleifenbaum
- Department of Orthopedic, Trauma, and Plastic Surgery, University of Leipzig, Liebigstraße 20, 04103 Leipzig, Germany; ZESBO - Center for Research on Musculoskeletal Systems, Semmelweisstrasse 14, 04103 Leipzig, Germany; Fraunhofer Institute for Machine Tools and Forming Technology, Nöthnitzer Straße 44, 01187 Dresden, Germany.
| | - Viktoria Nitsch
- ZESBO - Center for Research on Musculoskeletal Systems, Semmelweisstrasse 14, 04103 Leipzig, Germany.
| | - Pierre Hepp
- Department of Orthopedic, Trauma, and Plastic Surgery, University of Leipzig, Liebigstraße 20, 04103 Leipzig, Germany.
| | - Jan Theopold
- Department of Orthopedic, Trauma, and Plastic Surgery, University of Leipzig, Liebigstraße 20, 04103 Leipzig, Germany.
| |
Collapse
|
3
|
Zhu W, Liu F, Yu B, He J. Preparation of antibacterial acrylic bone cement with methacrylate derived from benzothiazole. J Mech Behav Biomed Mater 2021; 117:104403. [PMID: 33621864 DOI: 10.1016/j.jmbbm.2021.104403] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Revised: 02/09/2021] [Accepted: 02/11/2021] [Indexed: 12/30/2022]
Abstract
Methacrylate derived from benzothiazole (BTTMA) was incorporated into acrylic bone cement with a series of mass ratio (5 wt%, 10 wt%, and 15 wt%) with the aim to endow antibacterial activity. Properties such as dough time (tdough), setting time (tset), maximum temperature (Tpeak), fluid uptake, water solubility, mechanical properties, and biocompatibility of BTTMA containing bone cements were all investigated. Bone cement without BTTMA was used as control and named as plain cement. The results showed that, after incorporating BTTMA, tdough, flexural modulus, compressive strength of bone cements could be increased, while tset, Tpeak, fluid uptake, water solubility, and flexural strength would be reduced. All of BTTMA containing bone cements did not show hemolytic activity and cell toxicity, but only bone cement with 15 wt% of BTTMA showed antibacterial activity against Staphylococcus aureus (S. aureus).
Collapse
|
4
|
Robo C, Öhman-Mägi C, Persson C. Compressive fatigue properties of commercially available standard and low-modulus acrylic bone cements intended for vertebroplasty. J Mech Behav Biomed Mater 2018; 82:70-76. [PMID: 29571115 DOI: 10.1016/j.jmbbm.2018.03.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 03/02/2018] [Accepted: 03/05/2018] [Indexed: 12/28/2022]
Abstract
Vertebroplasty (VP) is a minimally invasive surgical procedure commonly used to relieve severe back pain associated with vertebral compression fractures. The poly(methyl methacrylate) bone cement used during this procedure is however presumed to facilitate the occurrence of additional fractures next to the treated vertebrae. A reason for this is believed to be the difference in stiffness between the bone cement and the surrounding trabecular bone. The use of bone cements with lower mechanical properties could therefore reduce the risk of complications post-surgery. While intensive research has been performed on the quasi-static mechanical properties of these cements, there is no data on their long-term mechanical properties. In the present study, the in vitro compressive fatigue performance as well as quasi-static mechanical properties of two commercially available acrylic bone cements - a low-modulus cement (Resilience®) and a standard cement (F20) from the same manufacturer - were determined. The quasi-static mechanical properties of the low-modulus and standard cements after 24 h of setting were in the range of other vertebroplastic cements (σ = 70-75 MPa; E= 1600-1900 MPa). F20 displayed similar mechanical properties over time in 37 °C phosphate buffered saline solution, while the mechanical properties of the Resilience® cement decreased gradually due to an increased porosity in the polymeric matrix. The standard cement exhibited a fatigue limit of approx. 47 MPa, whereas the low-modulus cement showed a fatigue limit of approx. 31 MPa. In summary, the low-modulus bone cement had a lower fatigue limit than the standard cement, as expected. However, this fatigue limit is still substantially higher than the stresses experienced by vertebral trabecular bone.
Collapse
Affiliation(s)
- Céline Robo
- Materials in Medicine Group, Division of Applied Materials Science, Department of Engineering Sciences, The Ångström Laboratory, Uppsala University, Uppsala, Sweden
| | - Caroline Öhman-Mägi
- Materials in Medicine Group, Division of Applied Materials Science, Department of Engineering Sciences, The Ångström Laboratory, Uppsala University, Uppsala, Sweden
| | - Cecilia Persson
- Materials in Medicine Group, Division of Applied Materials Science, Department of Engineering Sciences, The Ångström Laboratory, Uppsala University, Uppsala, Sweden.
| |
Collapse
|
5
|
Qu GX, Ying ZM, Zhao CC, Yan SG, Cai XZ. Mechanical Properties and Porosity of Acrylic Cement Bone Loaded with Alendronate Powder. Int J Med Sci 2018; 15:1458-1465. [PMID: 30443165 PMCID: PMC6216052 DOI: 10.7150/ijms.27759] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Accepted: 08/08/2018] [Indexed: 11/05/2022] Open
Abstract
Aseptic loosening is the most common complication of joint replacement. Previous studies showed that acrylic bone cement loaded with a commercially-available alendronate powder (APAC) had good promise against wear debris-mediated osteolysis for prevention of aseptic loosening. The purpose of the present study was to investigate the effect of adding alendronate powder to an acrylic bone cement on quasi-static mechanical properties (namely, compressive strength, compressive modulus, tensile strength, and flexural strength), fatigue life, porosity, and microstructure of the cement. The results showed that adding up to 1 wt./wt.% alendronate powder exerted no detrimental effect on any of the quasi-static mechanical properties. However, the fatigue life of APAC decreased by between ~17% and ~27 % and its porosity increased by between ~ 5-7 times compared with corresponding values for the control cement (no alendronate powder added). Fatigue life was negatively and significantly correlated with porosity. Considering that fatigue life of the cement plays a significant role in joint replacement survival, clinical use of APAC cannot be recommended.
Collapse
Affiliation(s)
- Guo-Xin Qu
- Department of Orthopaedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Jiang-Hong Road 1511, Hangzhou, China
| | - Zhi-Min Ying
- Department of Orthopaedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Jiang-Hong Road 1511, Hangzhou, China
| | - Chen-Chen Zhao
- Department of Orthopaedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Jiang-Hong Road 1511, Hangzhou, China
| | - Shi-Gui Yan
- Department of Orthopaedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Jiang-Hong Road 1511, Hangzhou, China
| | - Xun-Zi Cai
- Department of Orthopaedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Jiang-Hong Road 1511, Hangzhou, China
| |
Collapse
|
6
|
Hagan CP, Orr JF, Mitchell CA, Dunne NJ. Critical evaluation of pulse-echo ultrasonic test method for the determination of setting and mechanical properties of acrylic bone cement: influence of mixing technique. Ultrasonics 2015; 56:279-286. [PMID: 25260486 DOI: 10.1016/j.ultras.2014.08.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2012] [Revised: 07/24/2014] [Accepted: 08/09/2014] [Indexed: 06/03/2023]
Abstract
Currently there is no reliable objective method to quantify the setting properties of acrylic bone cements within an operating theatre environment. Ultrasonic technology can be used to determine the acoustic properties of the polymerising bone cement, which are linked to material properties and provide indications of the physical and chemical changes occurring within the cement. The focus of this study was the critical evaluation of pulse-echo ultrasonic test method in determining the setting and mechanical properties of three different acrylic bone cement when prepared under atmospheric and vacuum mixing conditions. Results indicated that the ultrasonic pulse-echo technique provided a highly reproducible and accurate method of monitoring the polymerisation reaction and indicating the principal setting parameters when compared to ISO 5833 standard, irrespective of the acrylic bone cement or mixing method used. However, applying the same test method to predict the final mechanical properties of acrylic bone cement did not prove a wholly accurate approach. Inhomogeneities within the cement microstructure and specimen geometry were found to have a significant influence on mechanical property predictions. Consideration of all the results suggests that the non-invasive and non-destructive pulse-echo ultrasonic test method is an effective and reliable method for following the full polymerisation reaction of acrylic bone cement in real-time and then determining the setting properties within a surgical theatre environment. However the application of similar technology for predicting the final mechanical properties of acrylic bone cement on a consistent basis may prove difficult.
Collapse
Affiliation(s)
- Christopher P Hagan
- School of Mechanical and Aerospace Engineering, Queen's University Belfast, Stranmillis Road, Belfast BT9 5AH, UK
| | - John F Orr
- School of Mechanical and Aerospace Engineering, Queen's University Belfast, Stranmillis Road, Belfast BT9 5AH, UK
| | - Christina A Mitchell
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Grosvenor Road, Belfast BT12 6BP, UK
| | - Nicholas J Dunne
- School of Mechanical and Aerospace Engineering, Queen's University Belfast, Stranmillis Road, Belfast BT9 5AH, UK.
| |
Collapse
|
7
|
Hsu YM, Liao CH, Wei YH, Fang HW, Hou HH, Chen CC, Chang CH. Daptomycin-loaded polymethylmethacrylate bone cement for joint arthroplasty surgery. Artif Organs 2013; 38:484-92. [PMID: 24571555 DOI: 10.1111/aor.12197] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Antibiotic-loaded acrylic bone cement has been frequently used as an infection prophylaxis or antibiotic-loaded spacer in infected arthroplasty. In addition, daptomycin has been used recently against broad spectrum Gram-positive organisms. The goal of this in vitro study is to investigate the bacteriacidal and mechanical properties of daptomycin-incorporated polymethylmethacrylate (PMMA) bone cement and evaluate its feasibility for clinical use. Daptomycin (0.5, 1, or 2 g) was premixed with 40 g of PMMA bone cement powder before curing. The mechanical properties of the daptomycin-loaded acrylic bone cement (DLABC) were estimated following standard guidance, and the release profile and kinetics of daptomycin from PMMA were analyzed. The antimicrobial efficacy of DLABC was determined with a zone of inhibition (ZOI) assay against Staphylococcus aureus, Staphylococcus epidermis, Enterococcus faecalis, and Enterococcus faecium, respectively. The results showed that the compressive strength, of PMMA bone cement, which was higher than 100 MPa in all groups, was sufficient according to ISO 5833 after incorporation of daptomycin. The encapsulated daptomycin was released for 2 weeks with a 9.59 ± 0.85%, 15.25 ± 0.69%, and 20.64 ± 20.33% released percentage on the first day in the low, mid, and high groups, respectively. According to the calculated release kinetics, incorporated daptomycin should be 3.3 times the original dose to double its release. Although all recipes of DLABC had a microbial inhibitory effect, the effect with a higher encapsulated amount of daptomycin was more significant. Therefore, we believe that daptomycin can be locally delivered from PMMA bone cement at the surgical site as a prophylactic or treatment for osteomyelitis against Gram-positive organisms with intact cement function.
Collapse
Affiliation(s)
- Yuan-Ming Hsu
- Division of Orthopaedics, Department of Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan; Graduate School of Biotechnology and Bioengineering, Yuan Ze University, Taoyuan, Taiwan
| | | | | | | | | | | | | |
Collapse
|