Mechanical evaluation of hip cement spacer reinforcement with stainless steel Kirschner wires, titanium and carbon rods, and stainless steel mesh

Abstract

Introduction: In two-stage treatments for infections after total hip arthroplasty, antibiotic-loaded cement spacers help treat the infection by antibiotic elution and prevent contraction. However, such spacers are weak and may fracture while awaiting replacement, impairing functionality. We evaluated whether a Kirschner wire (K-wire) mounted into the spacer reinforced its strength along with the effects of the reinforcing material, position, and intensity.

Methods: Spacers without reinforcing materials constituted the control group. As reinforcing materials, stainless steel K-wires (diameters 3 and 6 mm), titanium alloy and carbon fibers (diameter 3.175 mm), and stainless steel meshes (inner and outer diameters, 6 and 9 mm, respectively) were inserted into the spacer mold before filling with cement. The spacers complied with ISO 7206-4; a compressive load was applied using a testing machine with a velocity of 25.4 mm/min, and the maximum load was recorded. We used 1-3 K-wires positioned on the medial side, lateral side, neck only, and stem only and tested 3 specimens for each condition.

Results: The control group withstood the highest load. Stainless steel was the strongest material; 3-mm K-wires in the neck and lateral side withstood a higher load. The computed tomography (CT) imaging revealed a cavity between the K-wires and cement. When K-wires were inserted along the whole length, despite cement fractures, continuity was maintained because of the reinforcing materials.

Conclusion: It is difficult to improve the reinforcing strength of spacers using K-wires; however, K-wires prevented dislocation of cement spacer fragments, which can help prevent contraction and facilitate spacer removal during replacement.