Chinese Journal of Tissue Engineering Research ›› 2020, Vol. 24 ›› Issue (6): 821-826.doi: 10.3969/j.issn.2095-4344.2445

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Design and clinical application of personalized antibiotic cement spacer of knee joint

Wang Hong1, Wu Quan1, Tang Geng1, Zhang Gong2   

  1. 1School of Mechanical & Electrical Engineering, Guizhou Normal University, Guiyang 550025, Guizhou Province, China; 2Graduate School of Zunyi Medical University, Zunyi 563000, Guizhou Province, China
  • Received:2019-07-09 Revised:2019-07-10 Accepted:2019-08-20 Online:2020-02-28 Published:2020-01-16
  • Contact: Wu Quan, PhD, Associate professor, Master’s supervisor, School of Mechanical & Electrical Engineering, Guizhou Normal University, Guiyang 550025, Guizhou Province, China
  • About author:Wang Hong, Master candidate, School of Mechanical & Electrical Engineering, Guizhou Normal University, Guiyang 550025, Guizhou Province, China
  • Supported by:
    the Guizhou Normal University Graduate Innovation Foundation, No. YC[2018]027; the Foundation for Excellent Young Talents of Guizhou Province, No. [2015]05; the Science and Technology Program of Guizhou Province, No. [2016]7221; the Doctoral Foundation of Guizhou Normal University in 2014 

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Abstract:

BACKGROUND: Periprosthetic infection of the knee is one of the most serious complications after total knee arthroplasty. Second-stage revision is recognized as the “gold standard” of treatment. The placement of antibiotic cement spacer during the interval of the second operation not only increases the concentration of antibiotics, but also increases the joint activity of patients. At present, the fabrication methods of spacer are different. There are some shortcomings such as low articular surface fit, low fabrication accuracy, unstable structure and low strength, which cannot well fit the patient’s physiological structure. How to design personalized spacer and maintain knee joint stability after surgery is a difficulty in its clinical application.

OBJECTIVE: To design the structure of personalized spacer using finite element analysis and to make a spacer by three-dimensional printing technology for applied clinically.

METHODS: Based on CT data of knee joint from patients undergoing total knee arthroplasty, the prosthesis, femur and tibia were reconstructed by Mimics software. According to the amount of osteotomy and the shape of the prosthesis, a personalized spacer structure was designed. The stress of the spacer in different gaits was analyzed by finite element method. The silicone mould of the occupier was fabricated by three-dimensional printing technology and used in clinical application.

RESULTS AND CONCLUSION: (1) According to the amount of osteotomy and the shape of knee prosthesis, the structure of femoral side occupier and the tibial side occupier were designed. In order to prevent the dislocation of the spacer, the groove depth of the tibial side occupier was (4-6 mm) and the anterior end height was (10-14 mm). (2) The results of finite element analysis showed that the maximum stress of the femoral side occupier was 13.6 MPa at 90 degrees of flexion, and that of the tibial side occupier was 7.99 MPa at 90 degrees of flexion. The stress was reasonable and the structural strength of the spacer meets the requirements. (3) Silica gel mould of spacer was made by three-dimensional printing technology. The surface of spacer was smoother and the fit degree was increased. (4) The clinical results showed that the personalized spacer had good joint mobility and stability. (5) The spacer made by this method is fast, simple and saves operation time. It provides a new choice for clinical application of knee joint spacer.

Key words: total knee arthroplasty, second-stage revision, spacer, personalized, finite element analysis, three-dimensional printing

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