title: Articulating spacers used in two-stage revision of infected hip and knee prostheses abrade with time.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Clinic of Joint Replacement, General and Rheumatic Orthopaedics, Orthopaedic Clinic Markgröningen gGmbH, Kurt-Lindemann-Weg 10, 71706 Markgröningen, Germany. b.fink@okm.de
authors.forename: Bernd
authors.initials: B
authors.lastname: Fink
authors.forename: Annett
authors.initials: A
authors.lastname: Rechtenbach
authors.forename: Hubert
authors.initials: H
authors.lastname: Büchner
authors.forename: Sebastian
authors.initials: S
authors.lastname: Vogt
authors.forename: Michael
authors.initials: M
authors.lastname: Hahn
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects* / Q000295:instrumentation; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects* / Q000295:instrumentation; D001843:Bone Cements / Q000627:therapeutic use; D020878:Device Removal; D005260:Female; D005858:Germany; D006622:Hip Prosthesis / Q000009:adverse effects*; D006801:Humans; D017053:Infection Control / Q000379:methods; D007720:Knee Prosthesis / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D011475:Prosthesis Failure; D016459:Prosthesis-Related Infections / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D012086:Reoperation; D013052:Spectrometry, X-Ray Emission; D013054:Spectrophotometry, Atomic; D000074402:Synovectomy; D013583:Synovial Membrane / Q000737:chemistry / Q000473:pathology; D013997:Time Factors; D016896:Treatment Outcome; D014961:X-Ray Diffraction; D015040:Zirconium / Q000032:analysis
chemical_list: D000900:Anti-Bacterial Agents; D001843:Bone Cements; D015040:Zirconium; C028541:zirconium oxide