The Creation of Articulating Cement Spacer Using Custom-Fabricated Silicone Mold for the Treatment of Periprosthetic Joint Infection: Two Case Reports

Abstract

Joint replacement surgeries have been performed to treat joint arthropathies with excellent outcomes. As the number of joint replacement surgeries surges, the incidence of periprosthetic joint infection (PJI) has also increased. Currently, two-stage revision surgery is the gold standard in the treatment of periprosthetic joint infection. Two-stage revision surgery involves joint washout, the removal of the primary implant, the insertion of a cement spacer, and subsequently the reimplantation of prosthesis after the infection has been eliminated. Custom-made articulating cement spacer has been used with success to improve the patient's ambulatory status and quality of life. Nevertheless, custom-made articulating cement spacer or commercialized cement mold is generally costly. By the modification of previous authors' techniques, we manage to fabricate reusable silicone molds, which can be used to create articulating cement spacers for both hip and knee joints. We share two case reports to illustrate how these fabricated silicone molds can be a cost-effective technique to create articulating cement spacers to manage periprosthetic joint infection in both hip and knee joints. Surgeons in resource-deprived countries can utilize this technique to create articulating cement spacers with minimal cost, but they need to discuss with their patients and check with the local regulatory board on the feasibility of this technique to create cement spacer that will be used in a patient.

Keywords: cement spacer; cement spacer techniques; hip and knee replacement; infected hip arthroplasty; infected knee arthroplasty; mold; periprosthetic joint infection; pji.

Figure 1. (A) Thompson hemiarthroplasty implant is used to create the silicone mold. (B) Thompson hemiarthroplasty is fully submerged while waiting for the silicone mold to set. (C) Cement is injected into the silicone mold during the waiting phase. (D) The cement spacer is removed after the hardening phase. (E) The silicone mold can be reused after cleaning and sterilization.

Figure 2. (A) Post-operative plain radiograph in lateral view. (B) Post-operative plain radiograph in AP view. (C) The patient was able to weight-bear with aid. (D) Hip flexion is up to 70 degrees.

AP: anteroposterior

Figure 3. (A) The knee with periprosthetic joint infection is opened. (B) All the infected components are removed. (C) The cement spacer is inserted after thorough debridement and washout of the knee.

Figure 4. (A) Total knee replacement components are used to create the silicone mold. (B) Cement is injected into the silicone mold, and multiple Kirschner wires are inserted to increase the stability of the spacer. (C) The cement spacer is removed from the silicone mold after the hardening phase. (D) Kirschner wires are covered with cement to increase the surface area of antibiotic elucidation. (E) Similar technique is used to create the tibial part of the cement spacer. (F) The cement spacer is removed after the hardening phase. (G) The cement spacer is inspected prior to implantation.