Abstract
Introduction: We describe a novel, innovative and inexpensive method of producing a reinforced articulating cement spacer using a commercially available hip cement mould.
Methods: After adequate debridement and removal of original implants during the first of a two-stage revision procedure, an articulating cement spacer is created using a conventional mould and is reinforcing using a central stainless steel rod extending from the head to the tip using a novel technique that will be described in detail.
Results: We currently have a cohort of six consecutive patients in whom this novel cement spacer has been used. All patients were able to at least partially weight bear and none of the spacers fractured. Five have been explanted at second stage surgery after a minimum of 8 weeks in situ. One patient has been unable to undergo a second stage due to medical co morbidities and continues to mobilise with walking aids on the spacer 1-year post implantation.
Discussion: The articulating cement spacer described is produced using a technique that is simple, reproducible and allows a reinforced spacer to be created inexpensively without the need for special equipment. The spacer described provides a number of advantages over previously described or currently available commercial cement spacers. As it is reinforced it provides increased strength and allows partial weight bearing without risk of spacer fracture, a recognised complication of unreinforced spacers. As it uses a mould the surface remains smooth allowing easier insertion and minimising further bone loss with articulation. As it is fabricated intra-operatively, rather than being premanufactured, antibiotics can be added to the cement used to make the spacer according to known organism sensitivities.
Conclusion: We describe the first ever smooth, articulating, moulded cement spacer that can be inexpensively fabricated intra-operatively without the requirement for special equipment.
Correspondence should be addressed to The Secretary, BHS, c/o BOA, The Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London WC2A 3PE.
