Construction of an articulating antibiotic-loaded cement spacer

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Construction of an articulating antibiotic-loaded
cement spacer

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• Options for management of infected total hip
  arthroplasties include suppressive antibiotic
  therapy, irrigation and debridement ,excision
  arthroplasty,single-stage exchange arthroplasty
  ,and 2-stage exchange arthroplasty .
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• Although selection of the most appropriate choice
  of management must be individualized to the
  patient ,2-stage exchange arthroplasty is a
  popular choice in north america because of the
  low recurrence of infection when this protocol is
  used .
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• The interval insert of an antibiotic-loaded
  cement spacer is commonly used as part of a
  2-stage exchange protocol to deliver a high local
  concentration of antibiotics and to prevent soft
  tissue contractures that may complicate the
  second stage procedure .
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• The prosthesis of antibiotic-loaded acrylic
  cement , an articulating cement spacer,has
  been described as a solution to the problems
  of limb-length discrepancy and decreased
  mobility during the interval period in
  2-stage exchanges while maintaining a low
  rate of recurrent infection.
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• prosthesis also allows soft tissue planes
  to be maintained , making surgical Two
  different types of the PROSTALAC implant
  have been proposed one implant provides a
  cement-on-cement articulation , and the
  other custom-made prosthesis provides a
  metal-on-polyethylene articulation . in
  addition to providing a vehicle for the
  delivery of a high dose of local
  antibiotic therapy ,these devices allow the
  patient to use crutches more easily with
  toe-touch weight bearing on the involved
  extremity. The continued mobilization of
  the extremity provided by the dissection at
  the time of reimplantation easier.
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• We describe a simple method for the
  intraoperative construction of an
  articulating antibioticloaded cement spacer
  in the design of a bipolar hemiarthroplasty
  for use in 2-stage exchange arthroplasty
  of the hip .
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• Fig. 1. antibiotic-loaded cement is poured
  into the removed bulb of a syringe
  (arrow),and when it has reached a doughy
  consistency ,the femoral head of the
  prosthesis is inserted into it to form the
  metal-on cement articulation.

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• Fig. 2 . Appearance of the articulating
  spacer after removal of the bulb syringe
  to form a smooth surface that articulates
  with the acetabulum. The femoral component
  is coated with antibiotic-loaded cement
  before final insertion .

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• Fig .3. postoperative radiograph of the
  articulating antibiotic-loaded spacer in place.

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• Advantages of the articulating
  antibiotic-loaded cement spacer described
  include the use of materials already
  available in the operating room , the ease
  and speed in fashioning the spacer , a
  smooth cement-bone acetabular interface to
  minimize excessive bony wear ,and a
  constrained metal-on-cement articulation to
  minimize the risk of femoral head
  dislocation. The use of an articulating
  spacer allows for immediate limited weight
  bearing on the involved extremity ,an
  articulating hip joint with improved range
  of motion ,a vehicle for augmenting
  parenteral antibiotic therapy ,and maintenance
  of limb length.
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• See you next time !
• thank you

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