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. 2021 Nov 23;13(23):4065.
doi: 10.3390/polym13234065.

A Customized Knee Antibiotic-Loaded PMMA Spacer: A Preliminary Design Analysis

Marco Balato  1 , Carlo Petrarca  1 , Antonio Quercia  1 , Aniello Riccio  2   3 , Andrea Sellitto  2 , Jessica Campi  2 , Anna Borriello  3 , Mauro Zarrelli  3 , Giovanni Balato  4
Affiliations

A Customized Knee Antibiotic-Loaded PMMA Spacer: A Preliminary Design Analysis

Marco Balato et al. Polymers (Basel). .

Abstract

A preliminary design of customized antibiotic-loaded poly-methyl-methacrylate (ALPMMA) spacer characterized by an appropriate footprint according to the specific patient's anatomy and a reliable mechanical response to severe functional loads (i.e., level walking and 45° bent knee) is reported. The targeted virtual prototyping process takes origin from a novel patented 3D geometrical conceptualization characterized by added customization features and it is validated by a preliminary FEM-based analysis. Mechanical and thermomechanical properties of the antibiotic-doped orthopedic PMMA cement, which will be used for the future prototype manufacturing, were measured experimentally by testing samples taken during a real day-running orthopedic surgery and manufactured according to the surgeon protocol. FEM analysis results indicate that small area is subjected to intensive stresses, validating the proposed geometry from the mechanical point of view, under the two loading scenarios, moreover the value of safety margins results positive, and this is representative of the lower stress magnitude compared to the critical material limits. The experimental data confirm that the presence of antibiotic will last during the surgeon period moreover, the temperature dependent modulus of the bone cement is slightly affected by the body range temperature whereas it will drastically drop for higher temperature out the range of interest. A complete customization, according to a patient anatomy, and the corresponding real prototype spacer will be manufactured by 3D printing techniques, and it will be validated by destructive testing during the second stage of this activity before commercialization.

Keywords: 3D printing; FEM simulations; experimental analysis; spacer.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
3D view of the proposed ALPMMA: (a) femoral and (b) tibial component.
Figure 2
Figure 2
3D view of the proposed ALPMMA femoral component: (a) Anterior view, (b) top view and (c) A-P view.
Figure 3
Figure 3
3D view of the proposed augmented ALPMMA femoral component.
Figure 4
Figure 4
Top view of the proposed ALPMMA tibial component.
Figure 5
Figure 5
Hand mixed antibiotic cement taken from day surgery activity.
Figure 6
Figure 6
Compression test: (a) initial sample positioning; (b) compressed sample during the test.
Figure 7
Figure 7
Compression test results.
Figure 8
Figure 8
Three-point bending test.
Figure 9
Figure 9
Material property variation in extended temperature range detailed.
Figure 10
Figure 10
Weight loss reduction in air at isothermal temperatures.
Figure 11
Figure 11
The 10 TMA curves, respectively, (a) at room, (b) body and (c) extended temperature range along with (d) overlay of the curves below the glass transition temperature.
Figure 12
Figure 12
Finite Element Model of the joint replacement.
Figure 13
Figure 13
Test Case 1: Boundary conditions.
Figure 14
Figure 14
Test Case 2: Boundary conditions.
Figure 15
Figure 15
Test Case 1: Applied load and coupling constraints.
Figure 16
Figure 16
Test Case 2: Applied load and coupling constraints.
Figure 17
Figure 17
Test Case 1: Stress field and safety margins.
Figure 18
Figure 18
Test Case 2: Stress field and safety margins.
See this image and copyright information in PMC

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