Abstract
Articulating spacers should be wear-resistant and load-bearing to avoid prolonged immobilization of the patient and to reduce morbidity. However, due to the articulation of both components, a release of cement wear particles is to be expected. The aim of this study was to investigate the wear performance of a new spacer cement that contains calcium carbonate as a radio-opaque substance, in comparison to an established barium sulphate-containing spacer material, and also to characterize the amount, morphology, and size distributions of the released cement particles in detail. Force-controlled simulation was carried out on an AMTI knee simulator. The test parameters were in accordance with the standard ISO 14243-1 with a 50% reduced axial force. Tests were run for 500,000 cycles at a frequency of 1 Hz. For wear analysis, photographic documentation of the wear scars, gravimetric wear measurements and wear particle analysis were performed. The barium sulphate spacer material showed a total articular wear of 375.53 ± 161.22 mg. For the calcium carbonate-containing cement, reduced articular wear of 136.32 ± 37.58 mg was determined. Isolated cement wear particles of the barium sulphate-containing cement had a diameter of 0.429 ± 0.224 μm and were significantly larger compared to the calcium carbonate-containing cement (0.380 ± 0.216 μm, p = 0.02). The calcium carbonate-containing cement showed better wear performance in terms of gravimetric wear and particle release. Thus, calcium carbonate seems to be a promising material as a radio-opaque substrate in cement spacers.
Highlights
Periprosthetic infection is a serious and devastating complication in total hip and knee joint replacements, and one of the major reasons for revision surgery in joint arthroplasty [1,2].The preferred treatment option for chronic infection of a joint replacement is the use of antibiotic-impregnated polymethylmethacrylate (PMMA) bone cement spacers in a two-stage re-implantation procedure [3,4,5].Spacers may be articulating or non-articulating
Advantages of articulating mobile spacers include the possibility for the patient to move during the interim period, which may decrease the risk of muscle contracture due to immobilization and improve postoperative range of motion [3]
Calcium carbonate seems to be a promising material as a radio-opaque substrate in cement spacers
Summary
Periprosthetic infection is a serious and devastating complication in total hip and knee joint replacements, and one of the major reasons for revision surgery in joint arthroplasty [1,2].The preferred treatment option for chronic infection of a joint replacement is the use of antibiotic-impregnated polymethylmethacrylate (PMMA) bone cement spacers in a two-stage re-implantation procedure [3,4,5].Spacers may be articulating or non-articulating. The preferred treatment option for chronic infection of a joint replacement is the use of antibiotic-impregnated polymethylmethacrylate (PMMA) bone cement spacers in a two-stage re-implantation procedure [3,4,5]. Which type of spacer is used depends on several factors, including the condition of the soft tissues, the amount of bone loss, or the need for joint motion [6]. Due to the articulation of both cement components, a release of cement wear particles is expected [7]. These particles may have several biological consequences such as an involvement in proinflammatory reactions or osteolysis [8,9]
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