Klaus-Dieter Kühn – författare

Musculosketal infections are potentially devastating for the patient,his family and the health care services, as they may lead to functionalimpairment, long lasting disability, or even permanent handicap.This problem may also have socioeconomic implications. Infectioncommonly results in prolonged use of antibiotics, multiple operations,complications, extended rehabilitation and long lasting followupvisits with additional costs for the health care provider.This book covers contributions from international experts who cametogether in Potsdam, Germany, at the invitation of Professor HeinoKienapfel, MD PhD, of the Department of Special OrthopaedicSurgery and Traumatology of the Centre of Joint Arthroplasty,Auguste Viktoria Clinics Berlin.The focus of this book is the state of the art of:-Antimicrobial Resistances: Facts and Statistics- Arthroplasty Registers in EU: Status and Development- Microbiology in Arthroplasty- Strategies in Antibiotic Treatment- Spacer Management: Clinical Experiences and Requirements- Biofilm Creation: Low Grade Infection- Revision: Cemented vs. Cementless- Revision: One-stage vs. Two-stage treatment

Although the bone cement which are currently commercially available are all based on the same chemical substance (methyl methacrylate = MMA), their physical and chemical properties differ.

Methyl methacrylate (MMA) is the basic component of bone cements. To use it, a dough is prepared from the liquid and powder by mixing right before application, which is normally done by the operating team. During its working phase the dough is then inserted into the tissue where polymerization is completed. Thus, the final implant polymethyl­ methacrylate (PMMA) is only created at the implantation site. Besides methyl methacrylate, bone cements sometimes contain other methacrylates, such as butyl methacrylate. To achieve X-ray opacity, radiopacifiers (zirconium dioxide or barium sulfate) are added to the powder. Both the liquid and powder components contain additives (initiator and activator) that launch polymerization and control the set­ ting when mixed together. Moreover, softener and emulsifiers are some­ times used. The addition of antibiotics to the powder component in order to prevent or treat infections has become especially important. Commercial bone cements differ in composition and the course of curing. Some are designed for high and others for low viscosity. The way the user handles and applies the cement always crucially influences the quality of the implant. This is why clear and comprehensive information about the cements should be available to show the user how all the relevant factors work It should also be possible together and how they depend on each other.

In one-stage procedures, local agents are released from specialized antibiotic-loaded bone cements, while in two- or multi-stage procedures, local agents are released from corresponding temporary spacers (interim prostheses).

The Editors of “Essentials of Cemented Knee Arthroplasty” have compiled a comprehensive textbook on what many consider the most successful surgical procedure of the century.