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The "glove" technique: a modified method for femoral fixation of antibiotic-loaded hip spacers.

Anagnostakos K, Köhler D, Schmitt E, Kelm J - Acta Orthop (2009)

View Article: PubMed Central - PubMed

Affiliation: Klinik für Orthopädie und Orthopädische Chirurgie, Universitätskliniken des Saarlandes, Homburg/Saar, Germany. k.anagnostakos@web.de

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A special mold is also available for acetabular defects (Figure 2)... For clinical use, Refobacin-Palacos (0.5 g gentamicin/40 g cement) as bone cement has been shown to have elution characteristics that are better than those of other bone cements... The entire construction is removed after a minimum of 2 min, yielding a spacer that is a nearly exact anatomical copy of the proximal femoral part (Figure 5)... There is no risk that the spacer-glove complex will get stuck in the femur, as long as it is removed after 2 min—before the heat of polymerization has started... For implantation of an acetabular spacer, this is normally cemented... We do not consider that it is necessary to use the glove technique also for the acetabular component because if a dislocation occurs, this happens on the femoral side... Despite the wide use of hip spacers and an estimated dislocation rate of 10–20%, there is no consensus on the ideal femoral fixation method... The authors showed that with regard to the geometry a relatively small spacer femoral neck/head ratio should be aimed for (< 0.73), and deep insertion of the spacer into the femur is recommended (> 57 mm). and described 1/10 and 3/13 dislocations, respectively, after implantation of a standardized spacer... The “glove” technique allows spacer explantation in one piece without cement debris, thus reducing both mechanical complications and operating time... Over the past 7 years, we have observed that the “glove” technique gives a lower dislocation rate than the “press-fit” method, and that it allows a shorter reimplantation time compared with the “normal” cementation because no cement debris has to be removed from the femoral canal (unpublished data)... Based on these observations, this technique has become a standard procedure in our department... Moreover, another advantage is that this technique can also be used for other, commercially available hip spacers such as the Spacer G or those made by using the Biomet silicon molds.

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Mold, consisting of polyoxymethylene (POM), for standardized production of hip spacers. Each spacer has a head diameter of 50 mm, a stem length of 10 cm, and a total surface area of 13,300 mm2.
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Figure 0001: Mold, consisting of polyoxymethylene (POM), for standardized production of hip spacers. Each spacer has a head diameter of 50 mm, a stem length of 10 cm, and a total surface area of 13,300 mm2.

Mentions: In our department, we produce hip spacers by means of a two-parted mold (Figure 1). The mold consists of polyoxymethylene (POM). A special mold is also available for acetabular defects (Figure 2). For clinical use, Refobacin-Palacos (0.5 g gentamicin/40 g cement) as bone cement has been shown to have elution characteristics that are better than those of other bone cements (Anagnostakos et al. 2006). For the spacer prosthesis and the acetabular component, production of 80 g and 40 g of polymethylmethacrylate (PMMA), respectively, is required. Depending on the identity of the causative pathogen and its sensitivity profile, we sometimes load the bone cement with a second antibiotic. In cases of an unidentified bacterium preoperatively or if the infection was revealed during an operation for presumed aseptic conditions, we routinelly use the combination of 1 g gentamicin/4 g vancomycin/80 g PMMA. Each spacer has a head diameter of 50 mm, a stem length of 10 cm, and a total surface area of 13,300 mm2. The acetabular component has an inside/outside diameter of 53/56 mm and a total surface area of 4,410 mm2. When there is to be a combination of antibiotics, the second antibiotic is added manually to the Refobacin-Palacos powder. After thorough mixing, the cement’s liquid monomer is added. After attaining a doughy state, the cement is then poured into the two halves of the spacer mold. The halves are then clamped together. After 15 min, they are opened again and the molded spacer is removed.


The "glove" technique: a modified method for femoral fixation of antibiotic-loaded hip spacers.

Anagnostakos K, Köhler D, Schmitt E, Kelm J - Acta Orthop (2009)

Mold, consisting of polyoxymethylene (POM), for standardized production of hip spacers. Each spacer has a head diameter of 50 mm, a stem length of 10 cm, and a total surface area of 13,300 mm2.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2823223&req=5

Figure 0001: Mold, consisting of polyoxymethylene (POM), for standardized production of hip spacers. Each spacer has a head diameter of 50 mm, a stem length of 10 cm, and a total surface area of 13,300 mm2.
Mentions: In our department, we produce hip spacers by means of a two-parted mold (Figure 1). The mold consists of polyoxymethylene (POM). A special mold is also available for acetabular defects (Figure 2). For clinical use, Refobacin-Palacos (0.5 g gentamicin/40 g cement) as bone cement has been shown to have elution characteristics that are better than those of other bone cements (Anagnostakos et al. 2006). For the spacer prosthesis and the acetabular component, production of 80 g and 40 g of polymethylmethacrylate (PMMA), respectively, is required. Depending on the identity of the causative pathogen and its sensitivity profile, we sometimes load the bone cement with a second antibiotic. In cases of an unidentified bacterium preoperatively or if the infection was revealed during an operation for presumed aseptic conditions, we routinelly use the combination of 1 g gentamicin/4 g vancomycin/80 g PMMA. Each spacer has a head diameter of 50 mm, a stem length of 10 cm, and a total surface area of 13,300 mm2. The acetabular component has an inside/outside diameter of 53/56 mm and a total surface area of 4,410 mm2. When there is to be a combination of antibiotics, the second antibiotic is added manually to the Refobacin-Palacos powder. After thorough mixing, the cement’s liquid monomer is added. After attaining a doughy state, the cement is then poured into the two halves of the spacer mold. The halves are then clamped together. After 15 min, they are opened again and the molded spacer is removed.

View Article: PubMed Central - PubMed

Affiliation: Klinik für Orthopädie und Orthopädische Chirurgie, Universitätskliniken des Saarlandes, Homburg/Saar, Germany. k.anagnostakos@web.de

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

A special mold is also available for acetabular defects (Figure 2)... For clinical use, Refobacin-Palacos (0.5 g gentamicin/40 g cement) as bone cement has been shown to have elution characteristics that are better than those of other bone cements... The entire construction is removed after a minimum of 2 min, yielding a spacer that is a nearly exact anatomical copy of the proximal femoral part (Figure 5)... There is no risk that the spacer-glove complex will get stuck in the femur, as long as it is removed after 2 min—before the heat of polymerization has started... For implantation of an acetabular spacer, this is normally cemented... We do not consider that it is necessary to use the glove technique also for the acetabular component because if a dislocation occurs, this happens on the femoral side... Despite the wide use of hip spacers and an estimated dislocation rate of 10–20%, there is no consensus on the ideal femoral fixation method... The authors showed that with regard to the geometry a relatively small spacer femoral neck/head ratio should be aimed for (< 0.73), and deep insertion of the spacer into the femur is recommended (> 57 mm). and described 1/10 and 3/13 dislocations, respectively, after implantation of a standardized spacer... The “glove” technique allows spacer explantation in one piece without cement debris, thus reducing both mechanical complications and operating time... Over the past 7 years, we have observed that the “glove” technique gives a lower dislocation rate than the “press-fit” method, and that it allows a shorter reimplantation time compared with the “normal” cementation because no cement debris has to be removed from the femoral canal (unpublished data)... Based on these observations, this technique has become a standard procedure in our department... Moreover, another advantage is that this technique can also be used for other, commercially available hip spacers such as the Spacer G or those made by using the Biomet silicon molds.

Show MeSH