Radiography of the PROSTALAC (Prosthesis with Antibiotic-Loaded Acrylic Cement) Orthopedic Implant

Gee, Richard; Munk, Peter L.; Keogh, Cillian J.; Nicolaou, Savvas; Masri, Bassam A.; Marchinkow, Laurel O.; Ellis, John M.; Chan, Lai Peng

doi:10.2214/ajr.180.6.1801701

Cited by 15 publications

(7 citation statements)

References 6 publications

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“…PROSTALAC was initially developed for septic hip revisions and has since been applied to knee [ 41 , 42 ]. Typically, the system consists of a metal femoral component, a post-stabilized polyethylene tibial component, or a polyethylene acetabular liner [ 43 ]. A significant advantage is that it is designed to be semi-constrained to lower the risk of dislocation.…”

Section: Types Of Articulating Spacersmentioning

confidence: 99%

“…A significant advantage is that it is designed to be semi-constrained to lower the risk of dislocation. Structurally and functionally comparable to the traditional prosthesis, it may be a cost-effective temporary spacer that can reduce the complexity of the procedure [ 43 , 44 ]. In a 10- to 15-year follow-up study, 99 PJI patients using the PROSTALAC hip spacer attained an 89% long-term treatment success rate, demonstrating that it is a reliable and durable solution [ 45 ].…”

Section: Types Of Articulating Spacersmentioning

confidence: 99%

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Articulating spacers: what are available and how to utilize them?

Chen

2023

Arthroplasty

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Periprosthetic joint infection (PJI) is the most devastating complication following total joint arthroplasty (TJA) and is posing a global healthcare challenge as the demand for TJA mounts. Two-stage exchange arthroplasty with the placement of antibiotic-loaded spacers has been shown to be efficacious against chronic PJI. This study aimed to review the key concepts, types, and outcome evaluations of articulating spacers in the two-stage exchange for PJI. Previous studies indicated that articulating spacers have been widely used due to better functional improvement and a comparable infection control rate relative to static spacers. Several types of articulating spacers are reportedly available, including hand-made spacers, spacers fashioned from molds, commercially preformed spacers, spacers with additional metal or polyethylene elements, new or autoclaved prosthesis, custom-made articulating spacers, and 3D printing-assisted spacers. However, limited evidence suggested no significant difference in clinical outcomes among the different subtypes of articulating spacers. Surgeons should be familiar with different treatment strategies when using various spacers to know which is the most appropriate.

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Section: Types Of Articulating Spacersmentioning

confidence: 99%

Section: Types Of Articulating Spacersmentioning

confidence: 99%

Articulating spacers: what are available and how to utilize them?

Chen

2023

Arthroplasty

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“…Spacers with additional metal or plastic articulating elements incorporated within the cement (prosthesis with antibiotic-loaded acrylic cement, PROSTALAC) [6,22,33,34].…”

Section: Types Of Cement Spacersmentioning

confidence: 99%

“…Before the introduction of ALCS in two-stage revision arthroplasty for PJI, prolonged immobilization of the patient and the limb between the two stages resulted in muscle atrophy, soft tissue contraction, a short limb and joint stiffness [ 1 , 7 , 17 , 19 ]. Moreover, technically, the second-stage surgery was extremely difficult [ 1 , 6 , 22 ].…”

Section: Reviewmentioning

confidence: 99%

Current Concepts on the Application, Pharmacokinetics and Complications of Antibiotic-Loaded Cement Spacers in the Treatment of Prosthetic Joint Infections

Samelis¹,

Papagrigorakis²,

Sameli³

et al. 2022

Cureus

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Prosthetic joint infection (PJI) is a devastating complication of total joint replacement surgery. It affects about 2% of primary total joint replacements. Treatment aims at infection eradication and restoration of patient's mobility. Two-stage revision arthroplasty with an interim application of an antibiotic-loaded cement spacer (ALCS) is the widely accepted treatment for PJI. Spacers are powerful local carriers of antibiotics at the site of infection, effective against biofilm-protected microbes. On the other hand, spacers permit some mobility of the patient and facilitate final prosthesis implantation. ALCS's are either commercially available or prepared intraoperatively on prefabricated or improvised molds. Antibiotic elution from the spacer depends on the amount of the antibiotic used for cement impregnation, at the expense of mechanical stiffness of the spacer. The antibiotic should not exceed 4g per 40g of bone cement to preserve the mechanical properties of the cement. Spacers are frequently accompanied by local or systemic complications. The spacer may break, dislocate and compress vessels or nerves of the limb. Systemic complications are the result of excess elution of antibiotic and include nephrotoxicity, hepatotoxicity, ototoxicity, allergic reactions or neutropenia. Elderly patients with comorbidities are at risk to present such complications. Microbial resistance is a potential risk of long-lasting spacer retention. Persisting infection may require multiple spacer replacements.

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“…The PROSTALAC™ system consists of a metal-on-polyethylene articular surface and antibiotic-loaded PMMA (DePuy, Warsaw, IN, USA [ 116 , 117 ]. These can be created with commercially available mold or a homemade mold fabricated by the surgeon [ 118 ].…”

Section: Management Of Infection In Rtkamentioning

confidence: 99%

The Role of Poly(Methyl Methacrylate) in Management of Bone Loss and Infection in Revision Total Knee Arthroplasty: A Review

Hasandoost

Rodriguez

Alhalawani

et al. 2020

JFB

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Poly(methyl methacrylate) (PMMA) is widely used in joint arthroplasty to secure an implant to the host bone. Complications including fracture, bone loss and infection might cause failure of total knee arthroplasty (TKA), resulting in the need for revision total knee arthroplasty (rTKA). The goals of this paper are: (1) to identify the most common complications, outside of sepsis, arising from the application of PMMA following rTKA, (2) to discuss the current applications and drawbacks of employing PMMA in managing bone loss, (3) to review the role of PMMA in addressing bone infection following complications in rTKA. Papers published between 1970 to 2018 have been considered through searching in Springer, Google Scholar, IEEE Xplore, Engineering village, PubMed and weblinks. This review considers the use of PMMA as both a bone void filler and as a spacer material in two-stage revision. To manage bone loss, PMMA is widely used to fill peripheral bone defects whose depth is less than 5 mm and covers less than 50% of the bone surface. Treatment of bone infections with PMMA is mainly for two-stage rTKA where antibiotic-loaded PMMA is inserted as a spacer. This review also shows that using antibiotic-loaded PMMA might cause complications such as toxicity to surrounding tissue, incomplete antibiotic agent release from the PMMA, roughness and bacterial colonization on the surface of PMMA. Although PMMA is the only commercial bone cement used in rTKA, there are concerns associated with using PMMA following rTKA. More research and clinical studies are needed to address these complications.

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Radiography of the PROSTALAC (Prosthesis with Antibiotic-Loaded Acrylic Cement) Orthopedic Implant

Cited by 15 publications

References 6 publications

Articulating spacers: what are available and how to utilize them?

Articulating spacers: what are available and how to utilize them?

Current Concepts on the Application, Pharmacokinetics and Complications of Antibiotic-Loaded Cement Spacers in the Treatment of Prosthetic Joint Infections

The Role of Poly(Methyl Methacrylate) in Management of Bone Loss and Infection in Revision Total Knee Arthroplasty: A Review

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