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Do Dynamic Cement-on-Cement Knee Spacers Provide Better Function and Activity During Two-stage Exchange?
Journal article   Open access   Peer reviewed

Do Dynamic Cement-on-Cement Knee Spacers Provide Better Function and Activity During Two-stage Exchange?

David J. Jaekel, Judd S. Day, Gregg R. Klein, Harlan Levine, Javad Parvizi and Steven M. Kurtz
Clinical orthopaedics and related research, v 470(9), pp 2599-2604
2012
DOI: https://doi.org/10.1007/s11999-012-2332-5
PMID: 22476896
Featured in Collection :   UN Sustainable Development Goals @ Drexel
url
https://doi.org/10.1007/s11999-012-2332-5View
Published, Version of Record (VoR)Open Access (License Unspecified),  Open

Abstract

Clinical Research Conservative Orthopedics General Infection Medicine Medicine & Public Health Orthopedics Sports Medicine Surgery Surgical Orthopedics
Background Implantation of an antibiotic bone cement spacer is used to treat infection of a TKA. Dynamic spacers fashioned with cement-on-cement articulating surfaces potentially facilitate patient mobility and reduce bone loss as compared with their static counterparts, while consisting of a biomaterial not traditionally used for load-bearing articulations. However, their direct impact on patient mobility and wear damage while implanted remains poorly understood. Questions/purposes We characterized patient activity, surface damage, and porous structure of dynamic cement-on-cement spacers. Methods We collected 22 dynamic and 14 static knee antibiotic cement spacers at revision surgeries at times ranging from 0.5 to 13 months from implantation. For these patients, we obtained demographic data and UCLA activity levels. We characterized surface damage using the Hood damage scoring method and used micro-CT analysis to observe the internal structure, cracking, and porosity of the cement. Results The average UCLA score was higher for patients with dynamic spacers than for patients with static spacers, with no differences in BMI or age. Burnishing was the only prevalent damage mode on all the bearing surfaces. Micro-CT analysis revealed the internal structure of the spacers was porous and highly inhomogeneous, including heterogeneous dispersion of radiopaque material and cavity defects. The average porosity was 8% (range, 1%–29%) and more than ½ of the spacers had pores greater than 1 mm in diameter. Conclusions Our observations suggest dynamic, cement-on-cement spacers allow for increased patient activity without catastrophic failure. Despite the antibiotic loading and internal structural inhomogeneity, burnishing was the only prevalent damage mode that could be consistently classified with no evidence of fracture or delamination. The porous structure of the spacers varied highly across the surfaces without influencing the material failure.

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18 citations in Web of Science
26 citations in Scopus

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UN Sustainable Development Goals (SDGs)

This publication has contributed to the advancement of the following goals:

#3 Good Health and Well-Being

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Collaboration types
Industry collaboration
Domestic collaboration
Web of Science research areas
Orthopedics
Surgery
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