Clinic of Joint Replacement, General and Rheumatic Orthopaedics, Orthopaedic Clinic Markgröningen gGmbH, Kurt-Lindemann-Weg 10, 71706 Markgröningen, Germany.
Clin Orthop Relat Res. 2011 Apr;469(4):1095-102. doi: 10.1007/s11999-010-1479-1. Epub 2010 Jul 28.
Articulating spacers used in two-stage revision surgery of infected prostheses have the potential to abrade and subsequently induce third-body wear of the new prosthesis.
QUESTIONS/PURPOSES: We asked whether particulate material abraded from spacers could be detected in the synovial membrane 6 weeks after implantation when the spacers were removed for the second stage of the revision.
Sixteen hip spacers (cemented prosthesis stem articulating with a cement cup) and four knee spacers (customized mobile cement spacers) were explanted 6 weeks after implantation and the synovial membranes were removed at the same time. The membranes were examined by xray fluorescence spectroscopy, xray diffraction for the presence of abraded particles originating from the spacer material, and analyzed in a semiquantitative manner by inductively coupled plasma mass spectrometry. Histologic analyses also were performed.
We found zirconium dioxide in substantial amounts in all samples, and in the specimens of the hip synovial lining, we detected particles that originated from the metal heads of the spacers. Histologically, zirconium oxide particles were seen in the synovial membrane of every spacer and bone cement particles in one knee and two hip spacers.
The observations suggest cement spacers do abrade within 6 weeks. Given the presence of abrasion debris, we recommend total synovectomy and extensive lavage during the second-stage reimplantation surgery to minimize the number of abraded particles and any retained bacteria.
在感染性假体的两期翻修手术中使用的关节成形术间隔物具有磨损的潜力，并随后诱导新假体的三体磨损。
问题/目的：我们询问了在第二期翻修时取出间隔物时，植入后 6 周关节成形术间隔物磨损的颗粒物质是否可以在滑膜中检测到。
16 个髋关节间隔物（用水泥杯与水泥假体柄关节的固定假体）和 4 个膝关节间隔物（定制的活动水泥间隔物）在植入后 6 周被取出，同时取出滑膜。用 x 射线荧光光谱法、x 射线衍射法检测滑膜中是否存在来源于间隔物材料的磨损颗粒，并通过电感耦合等离子体质谱法进行半定量分析。还进行了组织学分析。
我们在所有样本中都发现了大量的二氧化锆，在髋关节滑膜衬里的标本中，我们检测到了来源于间隔物金属头的颗粒。组织学上，每个间隔物的滑膜中都可见氧化锆颗粒，一个膝关节和两个髋关节的间隔物中都可见骨水泥颗粒。
这些观察结果表明，在 6 周内水泥间隔物确实会磨损。鉴于存在磨损碎片，我们建议在第二期再植入手术中进行全滑膜切除术和广泛冲洗，以尽量减少磨损颗粒的数量和任何残留的细菌。
