Development of a Self-made Cement Bead Maker and Its Clinical Application for the Treatment of Periprosthetic Joint Infection

Abstract

Antibiotic-loaded acrylic cement beads have a large surface area and excellent sustained-release properties. However, there are some difficulty manufacturing reasonably sized beads and their careful handling. We developed a self-made cement bead maker using a mold of a sphere with a diameter of 8 and 10 mm with a 2-mm-diameter connecting hole. With this instrument, approximately 32 beads can be made from 40 g of bone cement. We clinically applied this technique to 11 cases of periprosthetic joint infection. There was no recurrence of infection noted. The advantages of this device were that it was possible to adjust the combination of antimicrobial agents and that the shape was uniform and easy to handle during surgery.

Keywords: Antibiotic-loaded acrylic cement; Cement beads; Periprosthetic joint infection.

Figure 1

Cement beads maker (Pearl Maker). (a) Unassembled devices that consist of a mold, core rod, and clamp. (b) Mold size options. Molds of 8 × 4 rows of 8-mm and 10-mm diameter. (c) A picture showing assembly with cement, pressing the mold between the clamps. (d) Opened after hardening (prototype mold). (e) Finished spherical bead of 10-mm diameter with 2-mm internal hole. (f) Assembled beads with suture.

Figure 2

Case 3: a 73-year-old man, infected loosening after right knee joint revision surgery. (a) At the time of the initial examination, loosening of the implant after revision knee arthroplasty. (b) After insertion of a combination of beads and handmade spacers. (c) After two-stage surgery.

Figure 3

Case 9: a 77-year-old woman with chronic infection after hemiarthroplasty in migration of the bipolar femoral head into the pelvis. (a) At the time of our initial examination, the bipolar head had migrated into the pelvis, and the leg was shortened. (b) A fracture occurred at the time of stem removal, and a wire ring was added for bead insertion. (c) Acetabular reconstruction with allogeneic bone grafting and femoral revision with a proximal femoral endoprosthesis.

Figure 4

Case 10: a 75-year-old female, infected loosening after left elbow arthroplasty. (a) Preoperatively, findings of implant loosening. (b) Cement beads were inserted into the medullary cavity. (c) Revision surgery with internal fixation was performed.

Figure 5

Case 11: a 66-year-old man with dislocation of the left acetabular component due to infectious loosening. (a) Preoperatively, the acetabular component was displaced and showed bone loss in the upper part of the acetabular. (b) An 8-mm-diameter bead was inserted into the large dead space in the proximal femur and acetabulum. (c) Acetabular reconstruction was performed with allogeneic bone grafting for the bone defect.