Acta Scientific Orthopaedics (ISSN: 2581-8635)

Research Article Volume 6 Issue 2

Antibiotic Elution from Cement: An In Vitro Study

Christy Graff1*, Rebecca Tang2 and Bradley Crick3

1Department of Orthopaedics, The University of Adelaide, The Women’s and Children’s Hospital, North Adelaide, The Royal Adelaide Hospital, Adelaide, Australia
2Austin Hospital, Victoria, Australia
3Frankston Hospital, Victoria, Australia

*Corresponding Author: Christy Graff, Department of Orthopaedics, The University of Adelaide, The Women’s and Children’s Hospital, North Adelaide, The Royal Adelaide Hospital, Adelaide, Australia.

Received: November 29, 2022; Published: January 10, 2023

Abstract

Prosthetic joint infection is a serious complication of total hip replacement. Cement removal during two stage revisions can be associated with significant morbidity. Exposing new surface area of cement may achieve therapeutic antibiotic elution.
Five blocks containing polymethylmethacrylate (PMMA) and vancomycin were stored in normal saline at 37oC and allowed to reach steady state. Different interventions to expose new surface area were performed at six weeks.
Post intervention, blocks with the greatest increase in surface area showed the greatest increase in vancomycin levels, the highest increase being 641.77% compared with the control (5.88%).
This study confirms antibiotics remain trapped within PMMA after elution ceases. Further release of vancomycin from cement occurs after exposing new surface area. This seems proportional to the exposed surface area size.

Keywords: Cement; Antibiotic; Elution; Total Hip Replacement; Infection

References

  1. Haaker R., et al. “Osteomyelitis after endoprostheses”. Orthopade 33 (2004): 431.
  2. Leone JM and Hanssen AD. “Management of infection at the site of a total knee arthroplasty”. Journal of Bone and Joint Surgery American 87 (2005): 2335.
  3. Zimmerli W., et al. “Prosthetic-joint infections”. New England Journal of Medicine 351 (2004): 1645.
  4. Buchholz HW., et al. “Antibiotic-loaded acrylic cement: current concepts”. Clinical Orthopaedics and Related Research 190 (1984): 96.
  5. Josefsson G., et al. “Prophylaxis with systemic antibiotics versus gentamicin bone cement in total hip arthroplasty. A five-year survey of 1688 hips”. Clinical Orthopaedics and Related Research 253 (1990): 173.
  6. Persson U., et al. “The economics of preventing revisions in total hip replacement”. Acta Orthopaedica Scandinavica 70 (1999): 163.
  7. Chiu FY., et al. “Cefuroxime-impregnated cement in primary total knee arthroplasty: a prospective, randomized study of three hundred and forty knees”. Journal of Bone and Joint Surgery American 84 (2002): 759.
  8. Volin SJ., et al. “Two-stage reimplantation of total joint infections: a comparison of resistant and non-resistant organisms”. Clinical Orthopaedics and Related Research 427 (2004): 94.
  9. Haleem AA., et al. “Mid-term to long-term follow-up of two-stage reimplantation for infected total knee arthroplasty”. Clinical Orthopaedics and Related Research 428 (2004): 35.
  10. West rich GH., et al. “Modern treatment of infected total knee arthroplasty with a 2-stage reimplantation protocol”. Journal of Arthroplasty 25 (2010): 1015.
  11. Akiyama H., et al. “Computer-assisted fluoroscopic navigation system for removal of distal femoral bone cement in revision total hip arthroplasty”. Journal of Arthroplasty 22 (2007): 445.
  12. Nelson CL. “Cemented femoral revision: technique and outcome”. American Journal of Orthopedics 31 (2002): 187.
  13. Charnley J. “Anchorage of the femoral head prosthesis to the shaft of the femur”. Journal of Bone and Joint Surgery British 42-B (1960): 28.
  14. Buchholz HW., et al. “Management of deep infection of total hip replacement”. Journal of Bone and Joint Surgery British 63-B (1981): 342.
  15. Diefenbeck M., et al. “Prophylaxis and treatment of implant-related infections by local application of antibiotics”. Injury2 (2006): 95.
  16. Jiranek WA., et al. “Antibiotic-loaded bone cement for infection prophylaxis in total joint replacement”. Journal of Bone and Joint Surgery American 88 (2006): 2487.
  17. Youngman JR., et al. “Antibiotic-loaded cement in revision joint replacement”. Hospital Medicine 64 (2003): 613.
  18. Pitto RP and Spika IA. “Antibiotic-loaded bone cement spacers in two-stage management of infected total knee arthroplasty”. International Orthopaedics 28 (2004): 129.
  19. Cerretani D., et al. “The in vitro elution characteristics of vancomycin combined with imipenem-cilastatin in acrylic bone-cements: A pharmacokinetic study”. Journal of Arthroplasty 17 (2002): 619.
  20. Anagnostakos K., et al. “Elution of gentamicin and vancomycin from polymethylmethacrylate beads and hip spacers in vivo”. Acta Orthopaedica 80 (2009): 193.
  21. Anagnostakos K and Kelm J. “Enhancement of antibiotic elution from acrylic bone cement”. Journal of Biomedical Materials Research - Part B: Applied Biomaterial 90 (2009): 467.
  22. Powles JW., et al. “Gentamicin release from old cement during revision hip arthroplasty”. Journal of Bone and Joint Surgery British 80-B (1998): 607.
  23. Törholm C., et al. “Total hip joint arthroplasty with gentamicin-impregnated cement. A clinical study of gentamicin excretion kinetics”. Clinical Orthopaedics and Related Research 181 (1983): 99.
  24. Jiranek W. “Antibiotic-loaded cement in total hip replacement: current indications, efficacy, and complications”. Orthopedics8 (2005): 873.
  25. Bayston R and Milner RD. “The sustained release of antimicrobial drugs from bone cement: An appraisal of laboratory investigations and their significance”. Journal of Bone and Joint Surgery British 64 (1982): 460.
  26. Law HT., et al.In vitro measurement and computer modelling of the diffusion of antibiotic in bone cement”. Journal of Biomedical Engineering 8 (1986): 149.
  27. Wahlig H and Dingeldein E. “Antibiotics and bone cements. Experimental and clinical long-term observations”. Acta Orthopaedica Scandinavica 51 (1980): 49.
  28. Kuechle DK., et al. “Elution of vancomycin, daptomycin, and amikacin from acrylic bone cement”. Clinical Orthopaedics and Related Research 264 (1991): 302.
  29. Schurman DJ., et al. “Antibiotic-acrylic bone cement composites. Studies of gentamicin and Palacos”. Journal of Bone and Joint Surgery American 60 (1978): 978.
  30. Wroblewski BM. “Leaching out from acrylic bone cement. Experimental evaluation”. Clinical Orthopaedics and Related Research 124 (1977): 311.
  31. Baker AS and Greenham LW. “Release of gentamicin from acrylic bone cement. Elution and diffusion studies”. Journal of Bone and Joint Surgery American 70 (1988): 1551-1557.
  32. Van de Belt H., et al. “Surface roughness, porosity and wettability of gentamicin-loaded bone cements and their antibiotic release”. Biomaterials 21 (2000): 1981.
  33. Mandziak DG., et al. “Cement-within-cement stem exchange using the collarless polished double-taper stem”. Journal of Arthroplasty 22 (2007): 1000.
  34. Anagnostakos K., et al. “Antibiotic-impregnated PMMA hip spacers: current status”. Acta Orthopaedica 77 (2006): 628.
  35. Hsieh P., et al. “High concentration and bioactivity of vancomycin and aztreonam eluted from Simplex cement spacers in two-stage revision of infected hip implants: A study of 46 patients at an average follow up of 107 days”. Journal of Orthopaedic Research 24 (2006): 1615.
  36. Bertazzoni Minelli E., et al. “Release of gentamicin and vancomycin from temporary human hip spacers in two-stage revision of infected arthroplasty”. Journal of Antimicrobial Chemotherapy 53 (2004): 329.
  37. Anagnostakos K., et al.In vitro evaluation of antibiotic release from and bacterial growth inhibition by antibiotic-loaded acrylic bone cement spacers”. Journal of Biomedical Materials Research Part B: Applied Biomaterials 72B (2005): 373.
  38. Cheng C., et al. “94 Degradation of vancomycin to CDP-1 as measured by the COBAS (R) INTEGRA”. Therapeutic Drug Monitoring 19 (1997): 570.
  39. Wood MJ., et al. “Stability of vancomycin in plastic syringes measured by high-performance liquid chromatography”. Journal of Clinical Pharmacy and Therapeutics 20 (1995): 319.
  40. Kwok AK., et al. “An in vitro study of ceftazidime and vancomycin concentrations in various fluid media: implications for use in treating endophthalmitis”. Investigative Ophthalmology and Visual Science 43 (2002): 1182.
  41. Holtom PD., et al. “Relation of surface area to in vitro elution characteristics of vancomycin-impregnated polymethylmethacrylate spacers”. American Journal of Orthopedics 27 (1998): 207.
  42. Hsieh P., et al. “Liquid gentamicin and vancomycin in bone cement: A potentially more cost-effective regimen”. Journal of Arthroplasty 24 (2009): 125.
  43. Tunney MM., et al. “Antimicrobial susceptibility of bacteria isolated from orthopedic implants following revision hip surgery”. Antimicrobial Agents and Chemotherapy 42 (1998): 3002.
  44. Breusch SJ and Kühn KD. “Bone cements based on polymethylmethacrylate”. Orthopade 32 (2003): 41.
  45. Adams K., et al.In vitro and in vivo evaluation of antibiotic diffusion from antibiotic-impregnated polymethylmethacrylate beads”. Clinical Orthopaedics and Related Research 278 (1992): 244.
  46. . “Evaluation of dietary nutrition status of adult Uighur residents in Kashi region of Xinjiang by means of dietary balance index”. Health Research04 (2018): 562-569+576.

Citation

Citation: Christy Graff., et al. “Antibiotic Elution from Cement: An In Vitro Study”.Acta Scientific Orthopaedics 6.2 (2023): 24-30.

Copyright

Copyright: © 2023 Christy Graff., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.




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