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Aydınoğlu A. Enhancing orthopedic outcomes: A comparative analysis of gentamicin sulphate and nanosilver in bone cement. Heliyon 2024; 10:e35189. [PMID: 39157348 PMCID: PMC11328090 DOI: 10.1016/j.heliyon.2024.e35189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 07/18/2024] [Accepted: 07/24/2024] [Indexed: 08/20/2024] Open
Abstract
Background Orthopedic surgeries frequently utilize bone cement, which can increase the risk of postoperative infections. Addressing this challenge, this study aims to enhance the mechanical, physical, and handling properties of bone cement by integrating gentamicin sulfate (GS) and nanosilver (nAg). The objective is to evaluate and compare the effects of these additives on properties such as compressive strength, flexural strength, doughing time, working time, setting time, and exothermic temperature. By doing so, the study seeks to identify a safer and more effective alternative to traditional antibiotics in bone cement formulations, thereby improving clinical outcomes in orthopedic procedures. Methods This research involved a comparative analysis of modified cements against standard cements, focusing on compressive strength, flexural strength, doughing time, working time, setting time, and exothermic temperature. Various bone cement samples with GS and nAg additives were prepared and tested in accordance with international standards (ISO 5833:2002 and ASTM F451). Statistical analysis, including one-way and two-way ANOVA tests, was used to assess the significance of the results. Results nAg-loaded cements exhibit mechanical and physical properties on par with or supe-rior to those of GS-loaded and standard cements. Notably, nAg incorporation leads to significantly lower exothermic temperatures, reducing the risk of thermal bone tissue damage. This finding highlights that nAg-loaded cement is a safer alternative. Alongside unaltered or enhanced strength, nAgs demonstrate promise for orthopedic applications, particularly in primary arthroplasty. Additionally, nAgs reduce doughing time, enhancing the practicality of these methods in surgical settings. Conclusions In conclusion, this study underscores the potential advantages of incorporating GSs and nAgs into bone cement. nAg-loaded cement offers improved properties and reduced infection risk, making it a valuable choice for orthopedic procedures. It enhances both mechanical performance and safety, addressing crucial concerns in orthopedic surgery.
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Affiliation(s)
- Aysu Aydınoğlu
- Yıldız Technical University, Faculty of Chemistry and Metallurgy, Department of Metallurgy and Materials Engineering, Istanbul, 34349, Turkiye
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Wilczyński M, Bieniek M, Krakowski P, Karpiński R. Cemented vs. Cementless Fixation in Primary Knee Replacement: A Narrative Review. MATERIALS (BASEL, SWITZERLAND) 2024; 17:1136. [PMID: 38473607 DOI: 10.3390/ma17051136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 02/13/2024] [Accepted: 02/26/2024] [Indexed: 03/14/2024]
Abstract
Knee osteoarthritis (OA) is one of the leading causes of disability around the globe. Osteoarthritis is mainly considered a disease affecting the elderly. However, more and more studies show that sports overuse, obesity, or congenital disorders can initiate a pathologic cascade that leads to OA changes in the younger population. Nevertheless, OA mostly affects the elderly, and with increasing life expectancy, the disease will develop in more and more individuals. To date, the golden standard in the treatment of the end-stage of the disease is total joint replacement (TJR), which restores painless knee motion and function. One of the weakest elements in TJR is its bonding with the bone, which can be achieved by bonding material, such as poly methyl-methacrylate (PMMA), or by cementless fixation supported by bone ingrowth onto the endoprosthesis surface. Each technique has its advantages; however, the most important factor is the revision rate and survivor time. In the past, numerous articles were published regarding TJR revision rate, but no consensus has been established yet. In this review, we focused on a comparison of cemented and cementless total knee replacement surgeries. We introduced PICO rules, including population, intervention, comparison and outcomes of TJR in a PubMed search. We identified 783 articles published between 2010 and 2023, out of which we included 14 in our review. Our review reveals that there is no universally prescribed approach to fixate knee prostheses. The determination of the most suitable method necessitates an individualized decision-making process involving the active participation and informed consent of each patient.
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Affiliation(s)
- Mikołaj Wilczyński
- Orthopaedic and Sports Traumatology Department, Carolina Medical Center, Pory 78, 02-757 Warsaw, Poland
| | - Michał Bieniek
- Orthopaedic and Sports Traumatology Department, Carolina Medical Center, Pory 78, 02-757 Warsaw, Poland
| | - Przemysław Krakowski
- Orthopaedic and Sports Traumatology Department, Carolina Medical Center, Pory 78, 02-757 Warsaw, Poland
- Department of Trauma Surgery and Emergency Medicine, Medical University of Lublin, Staszica 11, 20-081 Lublin, Poland
| | - Robert Karpiński
- Department of Machine Design and Mechatronics, Faculty of Mechanical Engineering, Lublin University of Technology, Nadbystrzycka 36, 20-618 Lublin, Poland
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Zaszczyńska A, Kołbuk D, Gradys A, Sajkiewicz P. Development of Poly(methyl methacrylate)/nano-hydroxyapatite (PMMA/nHA) Nanofibers for Tissue Engineering Regeneration Using an Electrospinning Technique. Polymers (Basel) 2024; 16:531. [PMID: 38399909 PMCID: PMC10893281 DOI: 10.3390/polym16040531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 02/12/2024] [Accepted: 02/14/2024] [Indexed: 02/25/2024] Open
Abstract
The study explores the in vitro biocompatibility and osteoconductivity of poly(methyl methacrylate)/nano-hydroxyapatite (PMMA/nHA) composite nanofibrous scaffolds for bone tissue engineering (BTE). Electrospun scaffolds, exhibiting both low and high fiber orientation, were investigated. The inclusion of hydroxyapatite nanoparticles enhances the osteoconductivity of the scaffolds while maintaining the ease of fabrication through electrospinning. SEM analysis confirms the high-quality morphology of the scaffolds, with successful incorporation of nHA evidenced by SEM-EDS and FTIR methods. DSC analysis indicates that nHA addition increases the PMMA glass transition temperature (Tg) and reduces stress relaxation during electrospinning. Furthermore, higher fiber orientation affects PMMA Tg and stress relaxation differently. Biological studies demonstrate the composite material's non-toxicity, excellent osteoblast viability, attachment, spreading, and proliferation. Overall, PMMA/nHA composite scaffolds show promise for BTE applications.
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Affiliation(s)
| | | | | | - Paweł Sajkiewicz
- Laboratory of Polymers & Biomaterials, Institute of Fundamental Technological Research, Polish Academy of Sciences, Pawinskiego 5b St., 02-106 Warsaw, Poland; (A.Z.); (D.K.); (A.G.)
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Cheng SH, Chou WH, Tsuei YC, Chu W, Chu WC. Assessment of Cement Leakage in Decompressed Percutaneous Kyphoplasty. J Clin Med 2024; 13:345. [PMID: 38256479 PMCID: PMC10816848 DOI: 10.3390/jcm13020345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 12/23/2023] [Accepted: 01/04/2024] [Indexed: 01/24/2024] Open
Abstract
Symptomatic osteoporotic compression fractures are commonly addressed through vertebroplasty and kyphoplasty. However, cement leakage poses a significant risk of neurological damage. We introduced "aspiration percutaneous kyphoplasty", also known as "decompressed kyphoplasty", as a method to mitigate cement leakage and conducted a comparative analysis with high viscosity cement vertebroplasty. We conducted a retrospective study that included 136 patients with single-level osteoporotic compression fractures. Among them, 70 patients underwent high viscosity cement vertebroplasty, while 66 patients received decompressed percutaneous kyphoplasty with low-viscosity cement. Comparison parameters included cement leakage rates, kyphotic angle alterations, and the occurrence of adjacent segment fractures. The overall cement leakage rate favored the decompressed kyphoplasty group (9.1% vs. 18.6%), although statistical significance was not achieved (p = 0.111). Nonetheless, the risk of intradiscal leakage significantly reduced in the decompressed kyphoplasty cohort (p = 0.011), which was particularly evident in cases lacking the preoperative cleft sign on X-rays. Kyphotic angle changes and the risk of adjacent segment collapse exhibited similar outcomes (p = 0.739 and 0.522, respectively). We concluded that decompressed kyphoplasty demonstrates efficacy in reducing intradiscal cement leakage, particularly benefiting patients without the preoperative cleft sign on X-rays by preventing intradiscal leakage.
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Affiliation(s)
- Shih-Hao Cheng
- Institute of Biomedical Engineering, National Yang-Ming Chiao-Tung University, Taipei 11221, Taiwan; (S.-H.C.); (Y.-C.T.); (W.C.)
- Department of Orthopedics, Cheng Hsin General Hospital, Taipei 11221, Taiwan;
| | - Wen-Hsiang Chou
- Department of Orthopedics, Cheng Hsin General Hospital, Taipei 11221, Taiwan;
| | - Yu-Chuan Tsuei
- Institute of Biomedical Engineering, National Yang-Ming Chiao-Tung University, Taipei 11221, Taiwan; (S.-H.C.); (Y.-C.T.); (W.C.)
- Department of Orthopedics, Cheng Hsin General Hospital, Taipei 11221, Taiwan;
| | - William Chu
- Institute of Biomedical Engineering, National Yang-Ming Chiao-Tung University, Taipei 11221, Taiwan; (S.-H.C.); (Y.-C.T.); (W.C.)
- Department of Orthopedics, Cheng Hsin General Hospital, Taipei 11221, Taiwan;
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei 11221, Taiwan
| | - Woei-Chyn Chu
- Institute of Biomedical Engineering, National Yang-Ming Chiao-Tung University, Taipei 11221, Taiwan; (S.-H.C.); (Y.-C.T.); (W.C.)
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Hofmann J, Bewersdorf TN, Sommer U, Lingner T, Findeisen S, Schamberger C, Schmidmaier G, Großner T. Impact of Antibiotic-Loaded PMMA Spacers on the Osteogenic Potential of hMSCs. Antibiotics (Basel) 2024; 13:44. [PMID: 38247603 PMCID: PMC10812455 DOI: 10.3390/antibiotics13010044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 12/28/2023] [Accepted: 01/02/2024] [Indexed: 01/23/2024] Open
Abstract
Antibiotic-loaded PMMA bone cement is frequently used in modern trauma and orthopedic surgery. Although many of the antibiotics routinely applied are described to have cytotoxic effects in the literature, clinical experience shows no adverse effects for bone healing. To determine the effects of antibiotic-loaded PMMA spacers on osteogenesis in vitro, we cultivated human bone marrow mesenchymal stem cells (BM-hMSCs) in the presence of PMMA spacers containing Gentamicin, Vancomycin, Gentamicin + Clindamycin as well as Gentamicin + Vancomycin in addition to a blank control (agarose) and PMMA containing no antibiotics. The cell number was assessed with DAPI staining, and the osteogenic potential was evaluated by directly measuring the amount of hydroxyapatite synthesized using radioactive 99mTc-HDP labelling as well as measuring the concentration of calcium and phosphate in the cell culture medium supernatant. The results showed that Gentamicin and Vancomycin as well as their combination show a certain amount of cytotoxicity but no negative effect on osteogenic potential. The combination of Gentamicin and Clindamycin, on the other hand, led to a drastic reduction in both the cell count and the osteogenic potential.
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Affiliation(s)
- Jakob Hofmann
- Clinic for Trauma and Reconstructive Surgery, Centre for Orthopedics, Trauma and Reconstructive Surgery and Paraplegiology, University Hospital Heidelberg, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany; (J.H.); (T.N.B.); (S.F.)
| | - Tim Niklas Bewersdorf
- Clinic for Trauma and Reconstructive Surgery, Centre for Orthopedics, Trauma and Reconstructive Surgery and Paraplegiology, University Hospital Heidelberg, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany; (J.H.); (T.N.B.); (S.F.)
| | - Ulrike Sommer
- Clinic for Trauma and Reconstructive Surgery, Centre for Orthopedics, Trauma and Reconstructive Surgery and Paraplegiology, University Hospital Heidelberg, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany; (J.H.); (T.N.B.); (S.F.)
| | - Thomas Lingner
- Genevention GmbH, Rudolf-Wissell-Str. 28A, 37079 Goettingen, Germany
| | - Sebastian Findeisen
- Clinic for Trauma and Reconstructive Surgery, Centre for Orthopedics, Trauma and Reconstructive Surgery and Paraplegiology, University Hospital Heidelberg, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany; (J.H.); (T.N.B.); (S.F.)
| | - Christian Schamberger
- Clinic for Trauma and Reconstructive Surgery, Centre for Orthopedics, Trauma and Reconstructive Surgery and Paraplegiology, University Hospital Heidelberg, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany; (J.H.); (T.N.B.); (S.F.)
| | - Gerhard Schmidmaier
- Clinic for Trauma and Reconstructive Surgery, Centre for Orthopedics, Trauma and Reconstructive Surgery and Paraplegiology, University Hospital Heidelberg, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany; (J.H.); (T.N.B.); (S.F.)
| | - Tobias Großner
- Clinic for Trauma and Reconstructive Surgery, Centre for Orthopedics, Trauma and Reconstructive Surgery and Paraplegiology, University Hospital Heidelberg, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany; (J.H.); (T.N.B.); (S.F.)
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Rudawska A, Szabelski J, Frigione M, Brunella V. Modification of Epoxides with Metallic Fillers-Mechanical Properties after Ageing in Aqueous Environments. MATERIALS (BASEL, SWITZERLAND) 2023; 16:7181. [PMID: 38005110 PMCID: PMC10672693 DOI: 10.3390/ma16227181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 10/31/2023] [Accepted: 11/10/2023] [Indexed: 11/26/2023]
Abstract
The aim of this research was a comparative analysis of selected mechanical properties of epoxy compounds that were modified with metallic fillers and aged in aqueous environments. The tested epoxy compounds consisted of three components: styrene modified epoxy resin based on Bisphenol A, triethylenetetramine curing agent (resin/curing agent ratio of 100:10) and two types of metallic fillers in the form of particles: aluminum alloy (EN AW-2024-AlCu4Mg1) and tin-phosphor bronze (CuSn10P). Samples were subjected to ageing in 4 water environments: low-, medium- and high-mineralized natural water and in a sugar-containing solution for 1, 2 and 3 months. The epoxy samples were subjected to compressive strength tests in accordance with the ISO 604:2002 standard. It was observed that, among others, the compositions seasoned in low-mineralized water usually achieved the highest average compressive strength. As for filler type, using the bronze filler (CuSn10P) usually achieved the highest average compressive strength results.
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Affiliation(s)
- Anna Rudawska
- Faculty of Mechanical Engineering, Lublin University of Technology, Nadbystrzycka 36, 20-618 Lublin, Poland;
- Department of Innovation Engineering, University of Salento, Via Arnesano, 73100 Lecce, Italy;
| | - Jakub Szabelski
- Faculty of Mechanical Engineering, Lublin University of Technology, Nadbystrzycka 36, 20-618 Lublin, Poland;
- Department of Innovation Engineering, University of Salento, Via Arnesano, 73100 Lecce, Italy;
| | - Mariaenrica Frigione
- Department of Innovation Engineering, University of Salento, Via Arnesano, 73100 Lecce, Italy;
| | - Valentina Brunella
- Department of Chemistry, University of Torino, Via P. Giuria 7, 10125 Torino, Italy;
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Chaurasiya SP, Ghosh R. A new mathematical model of compressive stress-strain behaviour of low viscosity and high viscosity bone cement with different strain rates. Med Eng Phys 2023; 117:104001. [PMID: 37331754 DOI: 10.1016/j.medengphy.2023.104001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 05/23/2023] [Accepted: 05/27/2023] [Indexed: 06/20/2023]
Abstract
A new mathematical model of compressive stress-strain behaviour of low viscosity (LV) and high viscosity (HV) bone cement has been proposed to capture large uniaxial deformation under constant applied strain rate by incorporating three-term power law. The modeling capacity of the proposed model has been validated using uniaxial compressive test under eight different low strain rates ranging from 1.39 × 10-4 s-1 to 3.53 × 10-2 s-1 for low viscosity and high viscosity bone cement. The well agreement between the model and experimental response suggests that the proposed model can successfully predict rate dependent deformation behavior for Poly(methyl methacrylate) (PMMA) bone cement. Additionally, the proposed model was compared with the generalized Maxwell viscoelastic model and found to be in good agreement. The comparison of compressive responses over low strain rates for LV and HV bone cement reveals their rate-dependent compressive yield stress behaviour along with a higher value of compressive yield stress of LV bone cement compared to HV bone cement. For example, at the strain rate of 1.39 × 10-4 s-1 the mean value of compressive yield stress of LV bone cement was found to be 64.46 MPa, whereas for HV bone cement it was 54.00 MPa. Moreover, the modeling of experimental compressive yield stress with the Ree-Eyring molecular theory suggests that the variation of yield stress of PMMA bone cement can be predicted using two processes Ree-Eyring theory. The proposed constitutive model might be useful to characterize large deformation behaviour with high accuracy for PMMA bone cement. Finally, both variants of PMMA bone cement also exhibit ductile-like compressive behaviour below the strain rate of 2.1 × 10-2 s-1, whereas above this threshold strain rate, brittle-like compressive failure behavior is observed.
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Affiliation(s)
- Sonalal Prasad Chaurasiya
- Biomechanics Research Laboratory, School of Mechanical and Materials Engineering, Indian Institute of Technology Mandi, Kamand, Mandi, 175075, Himachal Pradesh, India
| | - Rajesh Ghosh
- Biomechanics Research Laboratory, School of Mechanical and Materials Engineering, Indian Institute of Technology Mandi, Kamand, Mandi, 175075, Himachal Pradesh, India.
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Application of 3D Printing in Bone Grafts. Cells 2023; 12:cells12060859. [PMID: 36980200 PMCID: PMC10047278 DOI: 10.3390/cells12060859] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/05/2023] [Accepted: 03/08/2023] [Indexed: 03/12/2023] Open
Abstract
The application of 3D printing in bone grafts is gaining in importance and is becoming more and more popular. The choice of the method has a direct impact on the preparation of the patient for surgery, the probability of rejection of the transplant, and many other complications. The aim of the article is to discuss methods of bone grafting and to compare these methods. This review of literature is based on a selective literature search of the PubMed and Web of Science databases from 2001 to 2022 using the search terms “bone graft”, “bone transplant”, and “3D printing”. In addition, we also reviewed non-medical literature related to materials used for 3D printing. There are several methods of bone grafting, such as a demineralized bone matrix, cancellous allograft, nonvascular cortical allograft, osteoarticular allograft, osteochondral allograft, vascularized allograft, and an autogenic transplant using a bone substitute. Currently, autogenous grafting, which involves removing the patient’s bone from an area of low aesthetic importance, is referred to as the gold standard. 3D printing enables using a variety of materials. 3D technology is being applied to bone tissue engineering much more often. It allows for the treatment of bone defects thanks to the creation of a porous scaffold with adequate mechanical strength and favorable macro- and microstructures. Bone tissue engineering is an innovative approach that can be used to repair multiple bone defects in the process of transplantation. In this process, biomaterials are a very important factor in supporting regenerative cells and the regeneration of tissue. We have years of research ahead of us; however, it is certain that 3D printing is the future of transplant medicine.
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Zastulka A, Clichici S, Tomoaia-Cotisel M, Mocanu A, Roman C, Olteanu CD, Culic B, Mocan T. Recent Trends in Hydroxyapatite Supplementation for Osteoregenerative Purposes. MATERIALS (BASEL, SWITZERLAND) 2023; 16:1303. [PMID: 36770309 PMCID: PMC9919169 DOI: 10.3390/ma16031303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 01/27/2023] [Accepted: 01/31/2023] [Indexed: 06/18/2023]
Abstract
Bone regeneration has gained attention in the biomedical field, which has led to the development of materials and synthesis methods meant to improve osseointegration and cellular bone activity. The properties of hydroxyapatite, a type of calcium phosphate, have been researched to determine its advantages for bone tissue engineering, particularly its biocompatibility and ability to interact with bone cells. Recently, the advantages of utilizing nanomolecules of hydroxyapatite, combined with various substances, in order to enhance and combine their characteristics, have been reported in the literature. This review will outline the cellular and molecular roles of hydroxypatite, its interactions with bone cells, and its nano-combinations with various ions and natural products and their effects on bone growth, development, and bone repair.
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Affiliation(s)
- Ana Zastulka
- Physiology Department, Iuliu Hatieganu University of Medicine and Pharmacy, 1 Clinicilor Street, 400006 Cluj-Napoca, Romania
| | - Simona Clichici
- Physiology Department, Iuliu Hatieganu University of Medicine and Pharmacy, 1 Clinicilor Street, 400006 Cluj-Napoca, Romania
| | - Maria Tomoaia-Cotisel
- Department of Chemical Engineering, Faculty of Chemistry and Chemical Engineering, Research Center in Physical Chemistry, Babes-Bolyai University of Cluj-Napoca, 11 Arany Janos Str., 400028 Cluj-Napoca, Romania
- Academy of Romanian Scientists, 3 Ilfov Str., 050044 Bucharest, Romania
| | - Aurora Mocanu
- Department of Chemical Engineering, Faculty of Chemistry and Chemical Engineering, Research Center in Physical Chemistry, Babes-Bolyai University of Cluj-Napoca, 11 Arany Janos Str., 400028 Cluj-Napoca, Romania
| | - Cecilia Roman
- INCDO-INOE 2000, Research Institute for Analytical Instrumentation, 400296 Cluj-Napoca, Romania
| | - Cristian-Doru Olteanu
- Orthodontic Department, Iuliu Hatieganu University of Medicine and Pharmacy, 31 Avram Iancu Street, 400083 Cluj-Napoca, Romania
| | - Bogdan Culic
- Department of Prosthetic Dentistry and Dental Materials, Iuliu Hatieganu University of Medicine and Pharmacy, 32 Clinicilor Street, 400012 Cluj-Napoca, Romania
| | - Teodora Mocan
- Physiology Department, Iuliu Hatieganu University of Medicine and Pharmacy, 1 Clinicilor Street, 400006 Cluj-Napoca, Romania
- Nanomedicine Department, Regional Institute of Gastroenterology and Hepatology Cluj-Napoca, 5 Constanta Street, 400158 Cluj-Napoca, Romania
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Influence of the Type of Bone Cement Used in Two-Stage Exchange Arthroplasty for Chronic Periarticular Joint Infection on the Spacer Replacement and Reinfection Rate. J Clin Med 2023; 12:jcm12020600. [PMID: 36675529 PMCID: PMC9866783 DOI: 10.3390/jcm12020600] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 12/22/2022] [Accepted: 01/08/2023] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Antibiotic-loaded bone cement (ALBC) spacers are used in the first stage when treating periprosthetic joint infection (PJI). This study aimed to investigate whether a spacer made from commercial ALBC or plain bone cement with additional antibiotics could affect the spacer exchange rate before reimplantation. METHODS Patients undergoing two-stage exchange arthroplasty due to chronic PJI from January 2014 to August 2021 were retrospectively reviewed. The exclusion criteria included arthroplasty in the setting of septic arthritis, megaprosthesis, atypical pathogen infection, spacer placement unrelated to PJI, and spacer exchange due to mechanical complications. The patient demographics, brand of cement, and microbiology were recorded manually. The primary outcome was the incidence of spacer exchange due to persistent infection and the secondary outcome was the incidence of reinfection after reimplantation. A multivariate logistic regression analysis and Chi-square test were conducted to identify the effect of cement type on the spacer exchange. RESULTS A total of 334 patients underwent two-stage exchange arthroplasty for PJI. The spacer exchange rates in the commercial and non-commercial ALBC groups were 6.4% and 25.1%, respectively (p = 0.004). After controlling for confounding factors, there were significant differences between the commercial group and non-commercial groups in the spacer exchange rate (adjusted OR = 0.25; 95% CI = 0.72-0.87, p = 0.029). The use of commercial ALBC was not associated with a lower reinfection rate after reimplantation (p = 0.160). CONCLUSIONS In a two-stage exchange arthroplasty scenario, the spacer comprised of commercial ALBC resulted in a lower spacer exchange rate than the plain bone cement, both of which had additional antibiotics. However, the use of commercial ALBC was not associated with a lower incidence of reinfection following reimplantation.
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Szabelski J, Karpiński R, Jonak J, Frigione M. Adhesive Joint Degradation Due to Hardener-to-Epoxy Ratio Inaccuracy under Varying Curing and Thermal Operating Conditions. MATERIALS (BASEL, SWITZERLAND) 2022; 15:7765. [PMID: 36363357 PMCID: PMC9656023 DOI: 10.3390/ma15217765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 10/29/2022] [Accepted: 10/31/2022] [Indexed: 06/16/2023]
Abstract
This paper presents the results of an experimental study of adhesive joint strength with consideration of the inaccuracy of the hardener dosage, in the context of evaluating the degradation of joints when used either at ambient or elevated temperatures. The butt joint strength characteristics were assessed for two types of adhesives-rigid and flexible-and two curing scenarios-with and without heat curing. An excess hardener was shown to be significantly more unfavourable than its deficiency, which can ultimately be considered as a recommendation for forming epoxy adhesive joint assemblies. In order to fully understand the relationship between the analysed mechanical properties of the material and the influence of component ratio excesses and heating, a process of fitting basic mathematical models to the obtained experimental data was also performed.
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Affiliation(s)
- Jakub Szabelski
- Department of Computerisation and Production Robotisation, Faculty of Mechanical Engineering, Lubli University of Technology, Nadbystrzycka 36, 20-618 Lublin, Poland
- Department of Innovation Engineering, University of Salento, Provinciale Lecce-Monteroni, 73100 Lecce, Italy
| | - Robert Karpiński
- Department of Machine Design and Mechatronics, Faculty of Mechanical Engineering, Lublin University of Technology, Nadbystrzycka 36, 20-618 Lublin, Poland
| | - Józef Jonak
- Department of Machine Design and Mechatronics, Faculty of Mechanical Engineering, Lublin University of Technology, Nadbystrzycka 36, 20-618 Lublin, Poland
| | - Mariaenrica Frigione
- Department of Innovation Engineering, University of Salento, Provinciale Lecce-Monteroni, 73100 Lecce, Italy
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