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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time compared with the “normal” cementation because no cement debris has to be removed from the femoral canal (unpublished data)...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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Articulating hip spacer fixed according to the “glove technique” in situ.
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Figure 0007: Articulating hip spacer fixed according to the “glove technique” in situ.

Mentions: The glove is removed from the cement mantle around the spacer’s stem. Following the reinsertion of the stem (Figure 6), the remaining doughy cement is used for punctual fixation onto the femoral resection surface. After the cement has hardened, the spacer is reduced (Figure 7). 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. To our knowledge, there have been no reports about dislocation of an acetabular spacer and we have not seen any such case in our department.


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)

Articulating hip spacer fixed according to the “glove technique” in situ.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 0007: Articulating hip spacer fixed according to the “glove technique” in situ.
Mentions: The glove is removed from the cement mantle around the spacer’s stem. Following the reinsertion of the stem (Figure 6), the remaining doughy cement is used for punctual fixation onto the femoral resection surface. After the cement has hardened, the spacer is reduced (Figure 7). 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. To our knowledge, there have been no reports about dislocation of an acetabular spacer and we have not seen any such case in our department.

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.

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