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Monfort-Mira M, Jornet-Gibert M, Yela-Verdú C, Torner-Pifarré P, Balaguer-Castro M. [Translated article] In vitro elution of local anaesthetics from PMMA bone cement. Rev Esp Cir Ortop Traumatol (Engl Ed) 2024:S1888-4415(24)00064-X. [PMID: 38484939 DOI: 10.1016/j.recot.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 03/21/2023] [Accepted: 03/29/2023] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND AND AIM Currently, we do not have a gold standard for pain management after total knee arthroplasty. We may use one of more drug delivery systems, none of which are ideal. An ideal depot delivery system would provide therapeutic, nontoxic, doses of drug at the surgical side, especially during 72h postoperatively. The bone cement used in arthroplasties has been used as a drug delivery system, especially antibiotics, since 1970. Based on this principle, we developed this study with the aim to characterize the elution profile of two local anaesthetics (lidocaine hydrochloride and bupivacaine hydrochloride) from PMMA (polymethilmethacrylate) bone cement. MATERIAL AND METHODS Palacos® R+G bone cement and lidocaine hydrochloride or bupivacaine hydrochloride specimens were obtained depending on the study group. These specimens were immersed in PBS (phosphate buffered saline) and removed from the solution at different set times. Subsequently, the concentration of local anaesthetic in the liquid was analyzed by liquid chromatography. RESULTS The percentage of lidocaine eluted from PMMA bone cement in this study was 9.74% of the total lidocaine content per specimen at 72h and 18.73% at 336h (14 days). In case of bupivacaine, the elution percentage was 2.71% of the total bupivacaine content per specimen at 72h and 2.70% at 336h (14 days). CONCLUSIONS Local anaesthetics elute in vitro from PMMA bone cement, reaching doses at 72h close to the doses used in anaesthetic blocks.
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Affiliation(s)
- M Monfort-Mira
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Clínic, Barcelona, Spain
| | - M Jornet-Gibert
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Clínic, Barcelona, Spain
| | - C Yela-Verdú
- Departamento de Cirugía Ortopédica y Traumatología, Parc Taulí Hospital Universitari, Universitat Autònoma de Barcelona, Sabadell, Spain
| | - P Torner-Pifarré
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Clínic, Barcelona, Spain
| | - M Balaguer-Castro
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Clínic, Barcelona, Spain.
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Monfort-Mira M, Jornet-Gibert M, Yela-Verdú C, Torner-Pifarré P, Balaguer-Castro M. In vitro elution of local anesthetics from PMMA bone cement. Rev Esp Cir Ortop Traumatol (Engl Ed) 2023; 67:411-417. [PMID: 37023978 DOI: 10.1016/j.recot.2023.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 03/21/2023] [Accepted: 03/29/2023] [Indexed: 04/08/2023] Open
Abstract
BACKGROUND AND AIM Currently, we do not have a gold standard for pain management after total knee arthroplasty. We may use one of more drug delivery systems, none of which are ideal. An ideal depot delivery system would provide therapeutic, nontoxic, doses of drug at the surgical side, especially during 72h postoperatively. The bone cement used in arthroplasties has been used as a drug delivery system, especially antibiotics, since 1970. Based on this principle, we developed this study with the aim to characterize the elution profile of two local anesthetics (lidocaine hydrochloride and bupivacaine hydrochloride) from PMMA (polymethilmethacrylate) bone cement. MATERIAL AND METHODS Palacos® R+G bone cement and lidocaine hydrochloride or bupivacaine hydrochloride specimens were obtained depending on the study group. These specimens were immersed in PBS (phosphate buffered saline) and removed from the solution at different set times. Subsequently, the concentration of local anesthetic in the liquid was analyzed by liquid chromatography. RESULTS The percentage of lidocaine eluted from PMMA bone cement in this study was 9.74% of the total lidocaine content per specimen at 72h and 18.73% at 336h (14 days). In case of bupivacaine, the elution percentage was 2.71% of the total bupivacaine content per specimen at 72h and 2.70% at 336h (14 days). CONCLUSIONS Local anesthetics elute in vitro from PMMA bone cement, reaching doses at 72h close to the doses used in anesthetic blocks.
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Affiliation(s)
- M Monfort-Mira
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Clínic, Barcelona, España
| | - M Jornet-Gibert
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Clínic, Barcelona, España
| | - C Yela-Verdú
- Departamento de Cirugía Ortopédica y Traumatología, Parc Taulí Hospital Universitari, Universitat Autònoma de Barcelona, Sabadell, España
| | - P Torner-Pifarré
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Clínic, Barcelona, España
| | - M Balaguer-Castro
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Clínic, Barcelona, España.
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Monfort-Mira M, Jornet-Gibert M, Yela-Verdú C, Torner-Pifarré P, Balaguer-Castro M. [Translated article] In vitro elution of local anaesthetics from PMMA bone cement. Rev Esp Cir Ortop Traumatol (Engl Ed) 2023; 67:T411-T417. [PMID: 37311482 DOI: 10.1016/j.recot.2023.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 03/29/2023] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND AND AIM Currently, we do not have a gold standard for pain management after total knee arthroplasty. We may use one of more drug delivery systems, none of which are ideal. An ideal depot delivery system would provide therapeutic, nontoxic, doses of drug at the surgical side, especially during 72h postoperatively. The bone cement used in arthroplasties has been used as a drug delivery system, especially antibiotics, since 1970. Based on this principle, we developed this study with the aim to characterise the elution profile of two local anaesthetics (lidocaine hydrochloride and bupivacaine hydrochloride) from PMMA (polymethilmethacrylate) bone cement. MATERIAL AND METHODS Palacos® R+G bone cement and lidocaine hydrochloride or bupivacaine hydrochloride specimens were obtained depending on the study group. These specimens were immersed in PBS (phosphate buffered saline) and removed from the solution at different set times. Subsequently, the concentration of local anaesthetic in the liquid was analysed by liquid chromatography. RESULTS The percentage of lidocaine eluted from PMMA bone cement in this study was 9.74% of the total lidocaine content per specimen at 72h and 18.73% at 336h (14 days). In case of bupivacaine, the elution percentage was 2.71% of the total bupivacaine content per specimen at 72h and 2.70% at 336h (14 days). CONCLUSIONS Local anaesthetics elute in vitro from PMMA bone cement, reaching doses at 72h close to the doses used in anaesthetic blocks.
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Affiliation(s)
- M Monfort-Mira
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Clínic, Barcelona, Spain
| | - M Jornet-Gibert
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Clínic, Barcelona, Spain
| | - C Yela-Verdú
- Departamento de Cirugía Ortopédica y Traumatología, Parc Taulí Hospital Universitari, Universitat Autònoma de Barcelona, Sabadell, Spain
| | - P Torner-Pifarré
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Clínic, Barcelona, Spain
| | - M Balaguer-Castro
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Clínic, Barcelona, Spain.
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Hashimoto K, Nishimura S, Shinyashiki Y, Ito T, Kakinoki R, Akagi M. Novel reconstruction method by mega-prosthesis wrapped with vancomycin-containing cement after resection of malignancies. Medicine (Baltimore) 2022; 101:e31547. [PMID: 36482578 PMCID: PMC9726397 DOI: 10.1097/md.0000000000031547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
To introduce wrapping vancomycin-containing cement around a mega-prosthesis (MP) as a novel method to prevent prosthetic joint infection after reconstruction surgery for malignant bone and soft tissue tumors. Five patients with malignant bone and soft tissue tumors treated at our hospital from April 2009 to December 2019 were included. The average age was 71.4 years. Four males and one female were included. Three patients had a bone tumor, and two had a soft tissue tumor. Three right thighs and two left femurs were affected. These tumors were identified histologically as undifferentiated pleomorphic sarcoma, spindle cell sarcoma, diffuse large cell B-cell lymphoma, metastasis of renal cancer, and metastasis of lung cancer. All patients underwent tumor resection and reconstruction with a MP. In all cases, vancomycin-containing cement (2 g/40 g) was wrapped around the implant at the extension. The average follow-up period was 30.4 months. We surveyed whether infection occurred after surgical treatment. We also investigated the Musculoskeletal Tumor Society score and clinical outcome. We observed no postoperative infection. One case of local recurrence was observed, and a hip dissection was performed. The Musculoskeletal Tumor Society score was 79.26 ± 1.26 (mean ± standard deviation) (range: 76-80.3). Three patients remained disease-free, one survived but with disease, and one died of disease. Wrapping vancomycin-containing cement around the MP may be a useful method of preventing postoperative joint infections.
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Affiliation(s)
- Kazuhiko Hashimoto
- Department of Orthopedic Surgery, Kushimoto Municipal Hospital, Wakayama, Japan
- Department of Orthopedic Surgery, Kindai University Hospital, Osaka, Japan
- * Correspondence: Kazuhiko Hashimoto, Department of Orthopedic Surgery, Kindai University Hospital, 377-2 Ohno-higashi, Osaka-Sayama City, Osaka 589-8511, Japan (e-mail: )
| | - Shunji Nishimura
- Department of Orthopedic Surgery, Kindai University Hospital, Osaka, Japan
| | - Yu Shinyashiki
- Department of Orthopedic Surgery, Kushimoto Municipal Hospital, Wakayama, Japan
- Department of Orthopedic Surgery, Kindai University Hospital, Osaka, Japan
| | - Tomohiko Ito
- Department of Orthopedic Surgery, Kindai University Hospital, Osaka, Japan
| | - Ryosuke Kakinoki
- Department of Orthopedic Surgery, Kindai University Hospital, Osaka, Japan
| | - Masao Akagi
- Department of Orthopedic Surgery, Kindai University Hospital, Osaka, Japan
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Experimental Drillable Magnesium Phosphate Cement Is a Promising Alternative to Conventional Bone Cements. MATERIALS 2021; 14:ma14081925. [PMID: 33921373 PMCID: PMC8069694 DOI: 10.3390/ma14081925] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 04/02/2021] [Accepted: 04/07/2021] [Indexed: 11/17/2022]
Abstract
Clinically used mineral bone cements lack high strength values, absorbability and drillability. Therefore, magnesium phosphate cements have recently received increasing attention as they unify a high mechanical performance with presumed degradation in vivo. To obtain a drillable cement formulation, farringtonite (Mg3(PO4)2) and magnesium oxide (MgO) were modified with the setting retardant phytic acid (C6H18O24P6). In a pre-testing series, 13 different compositions of magnesium phosphate cements were analyzed concentrating on the clinical demands for application. Of these 13 composites, two cement formulations with different phytic acid content (22.5 wt% and 25 wt%) were identified to meet clinical demands. Both formulations were evaluated in terms of setting time, injectability, compressive strength, screw pullout tests and biomechanical tests in a clinically relevant fracture model. The cements were used as bone filler of a metaphyseal bone defect alone, and in combination with screws drilled through the cement. Both formulations achieved a setting time of 5 min 30 s and an injectability of 100%. Compressive strength was shown to be ~12–13 MPa and the overall displacement of the reduced fracture was <2 mm with and without screws. Maximum load until reduced fracture failure was ~2600 N for the cements only and ~3800 N for the combination with screws. Two new compositions of magnesium phosphate cements revealed high strength in clinically relevant biomechanical test set-ups and add clinically desired characteristics to its strength such as injectability and drillability.
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Tetzel L, Guyard M. Saving the lower limb with GlassBONE™ - Successful surgical revision of pseudarthrosis after infected open proximal tibia fracture type IIIC with bioactive glass grafting - A case report. Trauma Case Rep 2020; 31:100382. [PMID: 33426259 PMCID: PMC7779823 DOI: 10.1016/j.tcr.2020.100382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2020] [Indexed: 12/04/2022] Open
Abstract
Background The management of bone defect due to trauma or surgical debridement is a current problem in orthopedic trauma surgery, often complicated by infection and bone nonunion. The graft is one of the most challenging variables in surgical treatment. Bioactive Glass (BAG) as a biocompatible and osteogenic product is a promising bone substitute showing good results in maxillo-facial-, spine surgery and treatment of osteomyelitis. Surprisingly, there is very little data on BAG use in trauma surgery. Case presentation A 51-year-old male patient, involved in a motorcycle accident, suffered an open proximal tibia fracture, type IIIC, of the left leg. Patient was admitted in January of 2013 to a general orthopedic department for surgical treatment. After several surgical revisions due to infection, vascular damage, and bone nonunion, the patient was successfully treated with Masquelet therapy followed by GlassBONE™ grafting (GlassBONE™ 45S5; Norarker). The patient demonstrated excellent results over the course of a two-year follow-up. Conclusions In our experience, GlassBONE™ 45S5 has proven to be an effective bone substitute even in difficult grafting conditions, including multiple surgical revisions for bone nonunion and infection. In our case, at the end of 2 years and 3 months of follow-up, the patient reported no pain, and had no signs of infection. Bone union and full weight bearing was achieved. This case report is oriented by the CARE guidelines for clinical case reports; the patient gave consent for publication. GlassBONE™ 45S5 has proven to be an effective bone substitute even in difficult grafting conditions. Bone nonunion was successfully treated with Masquelet therapy followed by GlassBONE™ grafting. Bone loss due to fracture or surgical debridement is a current problem in orthopedic trauma surgery. Bone fractures are the most widespread trauma in humans.
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Affiliation(s)
- L Tetzel
- Orthopedic Department, University Children's Hospital Basel, Switzerland
| | - M Guyard
- Orthopedic Department, Centre Hospitalier Saint Joseph Saint Luc, Lyon, France
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Raucci MG, D'Amora U, Ronca A, Ambrosio L. Injectable Functional Biomaterials for Minimally Invasive Surgery. Adv Healthc Mater 2020; 9:e2000349. [PMID: 32484311 DOI: 10.1002/adhm.202000349] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 05/08/2020] [Indexed: 12/21/2022]
Abstract
Injectable materials represent very attractive ready-to-use biomaterials for application in minimally invasive surgical procedures. It is shown that this approach to treat, for example, vertebral fracture, craniofacial defects, or tumor resection has significant clinical potential in the biomedical field. In the last four decades, calcium phosphate cements have been widely used as injectable materials for orthopedic surgery due to their excellent properties in terms of biocompatibility and osteoconductivity. However, few clinical studies have demonstrated certain weaknesses of these cements, which include high viscosity, long degradation time, and difficulties being manipulated. To overcome these limitations, the use of sol-gel technology has been investigated, which has shown good results for synthesis of injectable calcium phosphate-based materials. In the last few decades, injectable hydrogels have gained increasing attention owing to their structural similarities with the extracellular matrix, easy process conditions, and potential applications in minimally invasive surgery. However, the need to protect cells during injection leads to the development of double network injectable hydrogels that are capable of being cross-linked in situ. This review will provide the current state of the art and recent advances in the field of injectable biomaterials for minimally invasive surgery.
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Affiliation(s)
- Maria Grazia Raucci
- Institute of Polymers, Composites and BiomaterialsNational Research Council (IPCB‐CNR) Viale J.F. Kennedy 54, Mostra d'Oltremare Pad.20 Naples 80125 Italy
| | - Ugo D'Amora
- Institute of Polymers, Composites and BiomaterialsNational Research Council (IPCB‐CNR) Viale J.F. Kennedy 54, Mostra d'Oltremare Pad.20 Naples 80125 Italy
| | - Alfredo Ronca
- Institute of Polymers, Composites and BiomaterialsNational Research Council (IPCB‐CNR) Viale J.F. Kennedy 54, Mostra d'Oltremare Pad.20 Naples 80125 Italy
| | - Luigi Ambrosio
- Institute of Polymers, Composites and BiomaterialsNational Research Council (IPCB‐CNR) Viale J.F. Kennedy 54, Mostra d'Oltremare Pad.20 Naples 80125 Italy
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Development of a heat labile antibiotic eluting 3D printed scaffold for the treatment of osteomyelitis. Sci Rep 2020; 10:7554. [PMID: 32371998 PMCID: PMC7200676 DOI: 10.1038/s41598-020-64573-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 04/02/2020] [Indexed: 12/17/2022] Open
Abstract
In general, osteomyelitis is treated with antibiotics, and in severe cases, the inflammatory bone tissue is removed and substituted with poly (methyl methacrylate) (PMMA) beads containing antibiotics. However, this treatment necessitates re-surgery to remove the inserted PMMA beads. Moreover, rifampicin, a primary heat-sensitive antibiotic used for osteomyelitis, is deemed unsuitable in this strategy. Three-dimensional (3D) printing technology has gained popularity, as it facilitates the production of a patient-customized implantable structure using various biodegradable biomaterials as well as controlling printing temperature. Therefore, in this study, we developed a rifampicin-loaded 3D scaffold for the treatment of osteomyelitis using 3D printing and polycaprolactone (PCL), a biodegradable polymer that can be printed at low temperatures. We successfully fabricated rifampicin-loaded PCL 3D scaffolds connected with all pores using computer-aided design and manufacturing (CAD/CAM) and printed them at a temperature of 60 °C to prevent the loss of the antibacterial activity of rifampicin. The growth inhibitory activity against Escherichia coli (E. coli) and Staphylococcus aureus (S. aureus), the representative causative organisms of osteomyelitis, was confirmed. In addition, we optimized the rifampicin-loading capacity that causes no damage to the normal bone tissues in 3D scaffold with toxicity evaluation using human osteoblasts. The rifampicin-releasing 3D scaffold developed herein opens new possibilities of the patient-customized treatment of osteomyelitis.
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Altering polymerization temperature of antibiotic-laden cement can increase porosity and subsequent antibiotic elution. INTERNATIONAL ORTHOPAEDICS 2018; 42:2627-2632. [PMID: 30219966 DOI: 10.1007/s00264-018-4135-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 08/28/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE To examine the role of polymerization temperature on the cement porosity and antibiotic elution to optimize antibiotic release from antibiotic-laden cement (ABLC). METHODS Elution profiles of vancomycin and tobramycin from ABLC discs prepared with low- and high-dose antibiotic dosages, cured at 8, 21, and 37 °C, and placed in phosphate buffered saline (PBS) at 37 °C were examined. Samples were collected at one, four, eight, 24, 72, 168, 336, and 1008 hours to calculate the quantity of antibiotic eluted. Porosity was determined by MicroCT analysis. RESULTS ABLC porosity and antibiotic elution were increased up to five times the amount eluted from room temperature discs (p < 0.05). Low-dose ABLC group saw decreased but similar porosity at 8 °C and 21 °C compared to cement cured at 37 °C (p < 0.001). High-dose ABLC group porosities were all significantly different (p < 0.02). CONCLUSIONS Altering the polymerization temperature of ABLC led to more porous constructs yielding increased antibiotic elution.
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Perni S, Martini-Gilching K, Prokopovich P. Controlling release kinetics of gentamicin from silica nano-carriers. Colloids Surf A Physicochem Eng Asp 2018. [DOI: 10.1016/j.colsurfa.2017.04.063] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Sanz-Ruiz P, Carbó-Laso E, Del Real-Romero JC, Arán-Ais F, Ballesteros-Iglesias Y, Paz-Jiménez E, Sánchez-Navarro M, Pérez-Limiñana MÁ, Vaquero-Martín J. Microencapsulation of rifampicin: A technique to preserve the mechanical properties of bone cement. J Orthop Res 2018; 36:459-466. [PMID: 28543702 DOI: 10.1002/jor.23614] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 05/19/2017] [Indexed: 02/04/2023]
Abstract
Two-stage exchange with antibiotic-loaded bone cement spacers remains the gold standard for chronic periprosthetic joint infection (PJI). Rifampicin is highly efficient on stationary-phase staphylococci in biofilm; however, its addition to PMMA to manufacture spacers prevents polymerization and reduces mechanical properties. Isolation of rifampicin during polymerization by microencapsulation could allow manufacturing rifampicin-loaded bone cement maintaining elution and mechanical properties. Microcapsules of rifampicin with alginate, polyhydroxybutyratehydroxyvalerate (PHBV), ethylcellulose and stearic acid (SA) were synthesized. Alginate and PHBV microcapsules were added to bone cement and elution, compression, bending, hardness, setting time and microbiological tests were performed. Repeated measures ANOVA and Bonferroni post-hoc test were performed, considering a p < 0.05 as statistical significance. Bone cement specimens containing alginate microcapsules eluted more rifampicin than PHBV microcapsules or non-encapsulated rifampicin over time (p < 0.012). Microencapsulation of rifampicin allowed PMMA to preserve mechanical properties in compression and bending tests. Cement with alginate microcapsules showed similar behavior in hardness tests to control cement over the study period (73 ± 1.68HD ). PMMA with alginate microcapsules exhibited the largest zones of inhibition in microbiological tests. Statistically significant differences in mean diameters of zones of inhibition between PMMA loaded with alginate-rifampicin (p = 0.0001) and alginate-PHBV microcapsules (p = 0.0001) were detected. Rifampicin microencapsulation with alginate is the best choice to introduce rifampicin in PMMA preserving mechanical properties, setting time, elution, and antimicrobial properties. The main applicability of this study is the opportunity for obtaining rifampicin-loaded PMMA by microencapsulation of rifampicin in alginate microparticles, achieving high doses of rifampicin in infected tissues, increasing the successful of PJI treatment. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:459-466, 2018.
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Affiliation(s)
- Pablo Sanz-Ruiz
- Department of Traumatology and Orthopaedic Surgery, University General Hospital Gregorio Marañon, Doctor Esquerdo 46, 28007, Madrid, Spain.,Complutense University of Madrid, Ciudad Universitaria, 28040, Madrid, Spain
| | - Esther Carbó-Laso
- Department of Traumatology and Orthopaedic Surgery, University General Hospital Gregorio Marañon, Doctor Esquerdo 46, 28007, Madrid, Spain
| | - Juan Carlos Del Real-Romero
- Institute for Research in Technology/Mechanical Engineering Department, Universidad Pontificia Comillas, Alberto Aguilera 23, 28015, Madrid, Spain
| | - Francisca Arán-Ais
- INESCOP Footwear Technological Institute Microencapsulation and Nanotechnology Elda, Políg. Ind. Campo Alto, Alemania 102, 03600, Elda, Alicante, Spain
| | - Yolanda Ballesteros-Iglesias
- Institute for Research in Technology/Mechanical Engineering Department, Universidad Pontificia Comillas, Alberto Aguilera 23, 28015, Madrid, Spain
| | - Eva Paz-Jiménez
- Institute for Research in Technology/Mechanical Engineering Department, Universidad Pontificia Comillas, Alberto Aguilera 23, 28015, Madrid, Spain
| | - Magdalena Sánchez-Navarro
- INESCOP Footwear Technological Institute Microencapsulation and Nanotechnology Elda, Políg. Ind. Campo Alto, Alemania 102, 03600, Elda, Alicante, Spain
| | - María Ángeles Pérez-Limiñana
- INESCOP Footwear Technological Institute Microencapsulation and Nanotechnology Elda, Políg. Ind. Campo Alto, Alemania 102, 03600, Elda, Alicante, Spain
| | - Javier Vaquero-Martín
- Department of Traumatology and Orthopaedic Surgery, University General Hospital Gregorio Marañon, Doctor Esquerdo 46, 28007, Madrid, Spain.,Complutense University of Madrid, Ciudad Universitaria, 28040, Madrid, Spain
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Ferrando A, Part J, Baeza J. Treatment of Cavitary Bone Defects in Chronic Osteomyelitis: Biogactive glass S53P4 vs. Calcium Sulphate Antibiotic Beads. J Bone Jt Infect 2017; 2:194-201. [PMID: 29119078 PMCID: PMC5671932 DOI: 10.7150/jbji.20404] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 09/20/2017] [Indexed: 12/31/2022] Open
Abstract
Aim: To evaluate the efficacy of bioglass (BAG-S53P4) in the treatment of patients with chronic osteomyelitis and compare the results with calcium sulphate antibiotic beads in one medical centre. Methods: Retrospective analysis of 25 cases. INCLUSION CRITERIA patients diagnosed clinically and radiographically of osteomyelitis and treated surgically (Group 1: cavitary bone defects treated with bioglass and Group 2: cavitary bone defects treated with calcium sulphate antibiotic beads) during the period of 2014 and 2015 in one medical centre. Results: Patients in group 1 (bioglass treatment): total of 12 patients (11 males and 1 female) with mean age: 50 years (30-86). Average length of hospital stay was 22 days and mean follow-up time: 23 months (16-33). Mean erythrocyte sedimentation rate (ESR) and mean c-reactive protein (CRP) before sugery: 55mm/hr and 54 mg/L, respectively. Mean ESR and mean CRP in last blood exam: 18 mm/hr and 8 mg/L, respectively. There were 2 postoperative complications: seroma formation and delayed wound healing. Only 1 patient had recurrence of infection. Patients in group 2 (calcium sulphate antibiotic beads treatment): total of 13 patients (9 males and 4 females) with mean age: 48 years (17-67). Average length of hospital stay was 21 days and mean follow-up time 22 months (16-29). Mean ESR and mean CRP before surgery: 51mm/hr and 41 mg/L, respectively. Mean ESR and mean CRP in last blood test: 15 mm/hr and 11 mg/L. 2 postoperative complications were registered: chronic expanding hematoma of the muscle flap donor site and seroma formation. 1 patient had recurrence of infection. Overall, there were no differences in recurrence of infection, p=0.740 and in complication rate, p=0.672. 11 (91,7%) patients in group 1 and 12 (92,3%) patients in group 2 showed no signs of recurrence of infection both clinically and radiologically at final follow-up. The most frequent cause of osteomyelitis in group 1 was post traumatic while a postsurgical aetiology was more frequent in group 2. The distal tibia was the most common location. The most frequent pathogen isolated in both groups was methicillin sensible staphylococcus aureus. Conclusions: An advance in treatment of patients with cavitary bone defects in chronic osteomyelitis is the use of synthetic bone substitutes although current evidence is low. In this study, we demonstrate how bioglass without local antibiotics and calcium sulphate antibiotic beads are both equally effective treatment options. Overall, there were no differences between groups in mean hospital stay, complication rates and recurrence of infection.
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Affiliation(s)
| | | | - Jose Baeza
- Departamento Traumatología y Cirugía Ortopédica, Hospital Universitari i Politècnic La Fe, Avinguda de Fernando Abril Martorell, nº 106, 46026 Valencia (Spain)
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In vivo serum concentration of vancomycin in antibiotic-loaded acrylic cement for the treatment and prevention of periprosthetic hip infection. J Orthop Sci 2017; 22:710-714. [PMID: 28342695 DOI: 10.1016/j.jos.2017.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 02/21/2017] [Accepted: 03/02/2017] [Indexed: 12/29/2022]
Abstract
BACKGROUND Although antibiotic-loaded acrylic cement (ALAC) is used to prevent and treat periprosthetic hip infection, it is unknown how much antibiotic is deposited in the body in vivo, how high the serum concentration rises, or how long its effects last. The aim of this study was firstly to determine the amount of vancomycin (VCM) deposited as ALAC in the body, and secondly to assess the safety and drug elution profile of VCM in ALAC. METHODS We administered VCM to prevent infection after total hip arthroplasty (THA) or to treat patients with methicillin-resistant Staphylococcus aureus. Patients were classified into two groups: a low-dose group (21 hips) that received primary THA for high-risk cases, revision THA without infection, or one-staged revision THA for infection; and a high-dose group (6 hips) that received cement beads during a two-staged revision THA. The amount of VCM placed as ALAC into the hip was calculated using the remaining ALAC. The serum concentrations of VCM and creatinine were evaluated at postoperative days 1, 4, 7, 14, and 28, and at 3 and 6 months. RESULTS The mean amount of VCM placed as ALAC into the hip was 0.9 g and 3.4 g for cemented THA and cement beads, respectively (P < 0.0001). The mean serum concentration of VCM from ALAC in the high-dose group was significantly increased compared with that in the low-dose group on postoperative days 1, 4, 7, 14, and 28 (P < 0.0001), but it remained within a clinically safe range. No significant differences were observed between the preoperative and postoperative serum creatinine levels of either group. CONCLUSION The average serum concentrations of VCM from ALAC were always less than the effective blood concentration, and were detectable until 6 months after surgery.
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14
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Karek MR, Jackson NM, Flynn JC, Vaidya R, Markel DC. Elution Profiles of Two Methods of Antibiotic Tibial Nail Preparations. Orthopedics 2017; 40:e436-e442. [PMID: 28135373 DOI: 10.3928/01477447-20170120-01] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 12/20/2016] [Indexed: 02/03/2023]
Abstract
Interlocking nails coated with antibiotic-supplemented cement provide effective treatment of infected long bone nonunion, but the thicker coating on guidewires may provide greater antibacterial activity. This study compared the properties of cement cured on each construct by evaluating 2-cm segments of 8-mm interlocking nails and 3.5-mm guidewires coated with antibiotic-supplemented cement. Each construct (n=7 for each group) was coated with polymethylmethacrylate cement (Simplex; Stryker Orthopaedics, Mahwah, New Jersey) containing either 1 g tobramycin or 1 g vancomycin powder plus 2.2 g tobramycin powder. A No. 40 French polyvinyl chloride chest tube was used as a mold for all constructs. Segments were soaked in sterile phosphate-buffered saline, and entire aliquots were exchanged at various intervals over a 6-week period. Antibiotic concentration, antibacterial activity, cement curing temperature, and porosity were measured. At least half of the total elution of antibiotics occurred within the first 24 hours for all constructs. For the tobramycin-only cement, no differences between constructs were observed. For constructs containing both antibiotics, interlocking nails showed more antibiotic release than guidewires at most time points (P<.05-P<.001). Antibiotics were released for 6 weeks and continued to inhibit Staphylococcus aureus growth. Cement curing temperatures for interlocking nails were lower than those for guidewires (P<.05). Guidewires coated with cement containing tobramycin and vancomycin showed significantly greater porosity compared with the other 3 groups (P<.05), but the amount of antibiotic released did not directly relate to porosity for any construct type. Interlocking nails coated with antibiotic-supplemented cement may provide greater antibiotic delivery to infected long bone nonunion compared with guidewires. A thin mantle of cement may allow greater elution, possibly as a result of cooler exothermic reactions. [Orthopedics. 2017; 40(3):e436-e442.].
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Abstract
Background and purpose - The bone cement market for total knee arthroplasty (TKA) in Norway has been dominated by a few products and distributors. Palacos with gentamicin had a market share exceeding 90% before 2005, but it was then withdrawn from the market and replaced by new slightly altered products. We have compared the survival of TKAs fixated with Palacos with gentamicin with the survival of TKAs fixated with the bone cements that took over the market. Patients and methods - Using data from the Norwegian Arthroplasty Register for the period 1997-2013, we included 26,147 primary TKAs in the study. The inclusion criteria were TKAs fixated with the 5 most used bone cements and the 5 most common total knee prostheses for that time period. 6-year Kaplan-Meier survival probabilities were established for each cement product. The Cox proportional hazards regression model was used to assess the association between bone cement product and revision risk. Separate analyses were performed with revision for any reason and revision due to deep infection within 1 year postoperatively as endpoints. Adjustments were made for age, sex, diagnosis, and prosthesis brand. Results - Survival was similar for the prostheses in the follow-up period, between the 5 bone cements included: Palacos with gentamicin, Refobacin Palacos R, Refobacin Bone Cement R (Refobacin BCR), Optipac Refobacin Bone Cement R (Optipac Refobacin BCR), and Palacos R + G. Interpretation - According to our findings, the use of the new bone cements led to a survival rate that was as good as with the old bone cement (Palacos with gentamicin).
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Affiliation(s)
- Øystein Birkeland
- Department of Clinical Medicine, Faculty of Medicine and Dentistry, University of Bergen,Correspondence: ØB:
| | - Birgitte Espehaug
- The Norwegian Arthroplasty Register, Department of Orthopedic Surgery, Haukeland University Hospital,Centre for Evidence-Based Practice, Bergen University College, Bergen, Norway
| | - Leif I Havelin
- Department of Clinical Medicine, Faculty of Medicine and Dentistry, University of Bergen,The Norwegian Arthroplasty Register, Department of Orthopedic Surgery, Haukeland University Hospital
| | - Ove Furnes
- Department of Clinical Medicine, Faculty of Medicine and Dentistry, University of Bergen,The Norwegian Arthroplasty Register, Department of Orthopedic Surgery, Haukeland University Hospital
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16
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Lee SH, Tai CL, Chen SY, Chang CH, Chang YH, Hsieh PH. Elution and Mechanical Strength of Vancomycin-Loaded Bone Cement: In Vitro Study of the Influence of Brand Combination. PLoS One 2016; 11:e0166545. [PMID: 27855203 PMCID: PMC5113949 DOI: 10.1371/journal.pone.0166545] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Accepted: 10/31/2016] [Indexed: 01/19/2023] Open
Abstract
Antibiotic-loaded bone cement (ALBC) is widely used in orthopaedic surgery for both prevention and treatment of infection. Little is known about the effect of different brand combinations of antibiotic and bone cement on the elution profile and mechanical strength of ALBC. Standardized specimens that consisted of one of the 4 brands of bone cement and one of the 3 brands of vancomycin were fashioned, producing 12 combinations of ALBC. Two dosages of vancomycin in 40g bone cement were used to represent the high (4g vancomycin) and low (1g vancomycin) dose groups. Concentrations of vancomycin elution from ALBC was measured for up to 336 hours. The ultimate compression strength was tested at axial compression using a material testing machine before and after elution. In both high-dose and low-dose groups, Lyo-Vancin in PALACOS bone cement resulted in the highest cumulative elution and Vanco in Simplex P bone cement resulted in the lowest elution (458% and 65% higher in high- and low-dose groups, respectively). The mechanical strength was not significantly compromised in all groups with low dose vancomycin (range: 70.31 ± 2.74 MPa to 87.28 ± 8.26MPa after elution). However, with the addition of high dose vancomycin, there was a mixed amount of reduction in the ultimate compression strength after cement aging, ranging from 5% (Vanco in Simplex P, 81.10 ± 0.48 MPa after elution) to 38% (Sterile vancomycin in CMW, 60.94 ± 5.74 MPa after elution). We concluded that the selection of brands of vancomycin and bone cement has a great impact on the release efficacy and mechanical strength of ALBC.
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Affiliation(s)
- Sheng-Hsun Lee
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Linkou, No. 5, Fuxing St., Guishan Dist., Taoyuan City, 333, Taiwan, R.O.C.,Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, No. 5, Fuxing St., Guishan Dist., Taoyuan City, 333, Taiwan, R.O.C
| | - Ching-Lung Tai
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Linkou, No. 5, Fuxing St., Guishan Dist., Taoyuan City, 333, Taiwan, R.O.C.,Graduate Institute of Medical Mechatronics, Chang Gung University, No. 259, Wenhua 1st Rd., Guidshan Dist., Taoyuan City, 333, Taiwan, R.O.C
| | - Szu-Yuan Chen
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Linkou, No. 5, Fuxing St., Guishan Dist., Taoyuan City, 333, Taiwan, R.O.C.,Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, No. 5, Fuxing St., Guishan Dist., Taoyuan City, 333, Taiwan, R.O.C
| | - Chih-Hsiang Chang
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Linkou, No. 5, Fuxing St., Guishan Dist., Taoyuan City, 333, Taiwan, R.O.C.,Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, No. 5, Fuxing St., Guishan Dist., Taoyuan City, 333, Taiwan, R.O.C
| | - Yu-Han Chang
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Linkou, No. 5, Fuxing St., Guishan Dist., Taoyuan City, 333, Taiwan, R.O.C.,Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, No. 5, Fuxing St., Guishan Dist., Taoyuan City, 333, Taiwan, R.O.C
| | - Pang-Hsin Hsieh
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Linkou, No. 5, Fuxing St., Guishan Dist., Taoyuan City, 333, Taiwan, R.O.C.,Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, No. 5, Fuxing St., Guishan Dist., Taoyuan City, 333, Taiwan, R.O.C
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17
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van der Voort P, Valstar ER, Kaptein BL, Fiocco M, van der Heide HJL, Nelissen RGHH. Comparison of femoral component migration between Refobacin bone cement R and Palacos R + G in cemented total hip arthroplasty: A randomised controlled roentgen stereophotogrammetric analysis and clinical study. Bone Joint J 2016; 98-B:1333-1341. [PMID: 27694586 DOI: 10.1302/0301-620x.98b10.37116] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2015] [Accepted: 05/12/2016] [Indexed: 11/05/2022]
Abstract
AIMS The widely used and well-proven Palacos R (a.k.a. Refobacin Palacos R) bone cement is no longer commercially available and was superseded by Refobacin bone cement R and Palacos R + G in 2005. However, the performance of these newly introduced bone cements have not been tested in a phased evidence-based manner, including roentgen stereophotogrammetric analysis (RSA). PATIENTS AND METHODS In this blinded, randomised, clinical RSA study, the migration of the Stanmore femoral component was compared between Refobacin bone cement R and Palacos R + G in 62 consecutive total hip arthroplasties. The primary outcome measure was femoral component migration measured using RSA and secondary outcomes were Harris hip score (HHS), Hip disability and Osteoarthritis Outcome Score (HOOS), EuroQol 5D (EQ-5D) and Short Form 36 (SF-36). RESULTS Femoral component migration was comparable between Refobacin bone cement R and Palacos R + G during the two-year follow-up period with an estimated mean difference of 0.06 mm of subsidence (p = 0.56) and 0.08° of retroversion (p = 0.82). Five hips (three Refobacin bone cement R and two Palacos R + G) showed non-stabilising, continuous migration; the femoral cement mantle in these hips, was mean 0.7 mm thicker (p = 0.02) and there were more radiolucencies at the bone-cement interface (p = 0.004) in comparison to hips showing stabilising migration. Post-operative HHS was comparable throughout the follow-up period (p = 0.62). HOOS, EQ5D, and SF-36 scores were also comparable (p-values > 0.05) at the two-year follow-up point. CONCLUSION Refobacin bone cement R and Palacos R + G show comparable component migration and clinical outcome during the first two post-operative years. Hips showing continuous migration are at risk for early failure. However, this seems to be unrelated to cement type, but rather to cementing technique. Cite this article: Bone Joint J 2016;98-B:1333-41.
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Affiliation(s)
- P van der Voort
- Leiden University Medical Center, Albinusdreef 2, J11-R-70, Leiden, 2333 ZA, The Netherlands
| | - E R Valstar
- Leiden University Medical Center, Albinusdreef 2, J11-R-70, Leiden, 2333 ZA, The Netherlands
| | - B L Kaptein
- Leiden University Medical Center, Albinusdreef 2, J11-R-70, Leiden, 2333 ZA, The Netherlands
| | - M Fiocco
- Leiden University Medical Center, Albinusdreef 2, J11-R-70, Leiden, 2333 ZA, The Netherlands
| | - H J L van der Heide
- Leiden University Medical Center, Albinusdreef 2, J11-R-70, Leiden, 2333 ZA, The Netherlands
| | - R G H H Nelissen
- Leiden University Medical Center, Albinusdreef 2, J11-R-70, Leiden, 2333 ZA, The Netherlands
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18
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Saleh KJ, El Othmani MM, Tzeng TH, Mihalko WM, Chambers MC, Grupp TM. Acrylic bone cement in total joint arthroplasty: A review. J Orthop Res 2016; 34:737-44. [PMID: 26852143 DOI: 10.1002/jor.23184] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 02/03/2016] [Indexed: 02/04/2023]
Abstract
Acrylic bone cement has a variety of applications in orthopedic surgery. Primary uses in total arthroplasties are limited to prostheses fixation and antibiotic delivery. With the large number of total joint arthroplasties expected to continue to rise, understanding the role bone cement plays in the success of total joint arthroplasty can have a significant impact on daily practice. The literature is inconclusive on whether cemented or cementless fixation technique is superior, and choice of fixation type is mainly determined by surgeon preference and experience. Surgeons should understand that if poor techniques exist, short-term outcomes of the replaced joint may be at risk. Statement of clinical significance: This article attempts to clarify some points of bone cement use through a review of the mechanical properties related to bone cement, a comparison to alternative materials, influence of additives, and the effects on surgical outcomes. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:737-744, 2016.
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Affiliation(s)
- Khaled J Saleh
- Division of Orthopaedics and Rehabilitation, Department of Surgery, Southern Illinois University School of Medicine, Springfield, Illinois, 62794-9679
| | - Mouhanad M El Othmani
- Division of Orthopaedics and Rehabilitation, Department of Surgery, Southern Illinois University School of Medicine, Springfield, Illinois, 62794-9679
| | - Tony H Tzeng
- Division of Orthopaedics and Rehabilitation, Department of Surgery, Southern Illinois University School of Medicine, Springfield, Illinois, 62794-9679
| | - William M Mihalko
- Campbell Clinic Department of Orthopaedic Surgery & Biomedical Engineering, University of Tennessee, 956 Court Ave, Suite E226, Memphis, Tennessee, 38163
| | - Monique C Chambers
- Division of Orthopaedics and Rehabilitation, Department of Surgery, Southern Illinois University School of Medicine, Springfield, Illinois, 62794-9679
| | - Thomas M Grupp
- Clinic for Orthopaedic Surgery, Campus Grosshadern, Ludwig Maximilians University, Munich, Germany Aesculap AG, Research & Development, Tuttlingen, Germany
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19
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Paz E, Sanz-Ruiz P, Abenojar J, Vaquero-Martín J, Forriol F, Del Real JC. Evaluation of Elution and Mechanical Properties of High-Dose Antibiotic-Loaded Bone Cement: Comparative "In Vitro" Study of the Influence of Vancomycin and Cefazolin. J Arthroplasty 2015; 30:1423-9. [PMID: 25791672 DOI: 10.1016/j.arth.2015.02.040] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2014] [Revised: 02/22/2015] [Accepted: 02/28/2015] [Indexed: 02/01/2023] Open
Abstract
Use of antibiotic-loaded bone cements is one of the most effective methods for the prevention and treatment of prosthetic joint infection. However, there is still controversy about the optimal combination and doses of antibiotics that provide the maximum antimicrobial effect without compromising cement properties. In this study, vancomycin and cefazolin were added to a bone cement (Palacos R+G). Antibiotic release, fluid absorption, and mechanical properties were evaluated under physiological conditions. The results show that the type of antibiotic selected has an important impact on cement properties. In this study, groups with cefazolin showed much higher elution than those containing the same concentration of vancomycin. In contrast, groups with cefazolin showed a lower strength than vancomycin groups.
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Affiliation(s)
- Eva Paz
- Institute for Research in Technology/Mechanical Engineering Department, Universidad Pontificia Comillas, Madrid, Spain
| | - Pablo Sanz-Ruiz
- Department of Traumatology and Orthopaedic Surgery, General University Hospital Gregorio Marañón, Madrid, Spain.
| | - Juana Abenojar
- Materials Performance Group, Materials Science and Engineering Department, Universidad Carlos III de Madrid, Spain
| | - Javier Vaquero-Martín
- Department of Traumatology and Orthopaedic Surgery, General University Hospital Gregorio Marañón, Madrid, Spain
| | | | - Juan Carlos Del Real
- Institute for Research in Technology/Mechanical Engineering Department, Universidad Pontificia Comillas, Madrid, Spain
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20
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Lewis G. Not all approved antibiotic-loaded PMMA bone cement brands are the same: ranking using the utility materials selection concept. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2015; 26:5388. [PMID: 25595722 DOI: 10.1007/s10856-015-5388-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 09/16/2014] [Indexed: 06/04/2023]
Abstract
In the literature on in vitro characterization of approved antibiotic-loaded poly(methyl methacrylate) bone cement brands, there is no information on the basis for selection of a given brand for use in cemented arthroplasties. This shortcoming is addressed in the present study. It involved determining four key properties (fatigue limit, fracture toughness, polymerization rate, and phosphate buffered saline diffusion coefficient) for six brands and then using the mean property values, in conjunction with a materials selection methodology, called the utility concept, to rank the brands. It is emphasized that the present work is an illustration of a rational approach to selection of a cement brand and, as such, the study findings are not intended to be recommendations regarding clinical use or otherwise of a brand.
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Affiliation(s)
- Gladius Lewis
- Department of Mechanical Engineering, The University of Memphis, Memphis, TN, 38152, USA,
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21
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Chang YH, Tai CL, Hsu HY, Hsieh PH, Lee MS, Ueng SWN. Liquid antibiotics in bone cement: an effective way to improve the efficiency of antibiotic release in antibiotic loaded bone cement. Bone Joint Res 2014; 3:246-51. [PMID: 25104836 PMCID: PMC4127657 DOI: 10.1302/2046-3758.38.2000305] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Objectives The objective of this study was to compare the elution characteristics,
antimicrobial activity and mechanical properties of antibiotic-loaded
bone cement (ALBC) loaded with powdered antibiotic, powdered antibiotic
with inert filler (xylitol), or liquid antibiotic, particularly focusing
on vancomycin and amphotericin B. Methods Cement specimens loaded with 2 g of vancomycin or amphotericin
B powder (powder group), 2 g of antibiotic powder and 2 g of xylitol
(xylitol group) or 12 ml of antibiotic solution containing 2 g of
antibiotic (liquid group) were tested. Results Vancomycin elution was enhanced by 234% in the liquid group and
by 12% in the xylitol group compared with the powder group. Amphotericin
B elution was enhanced by 265% in the liquid group and by 65% in
the xylitol group compared with the powder group. Based on the disk-diffusion
assay, the eluate samples of vancomycin-loaded ALBC of the liquid group
exhibited a significantly larger inhibitory zone than samples of
the powder or the xylitol group. Regarding the ALBCs loaded with
amphotericin B, only the eluate samples of the liquid group exhibited
a clear inhibitory zone, which was not observed in either the xylitol
or the powder groups. The ultimate compressive strength was significantly
reduced in specimens containing liquid antibiotics. Conclusions Adding vancomycin or amphotericin B antibiotic powder in distilled
water before mixing with bone cement can significantly improve the
efficiency of antibiotic release than can loading ALBC with the
same dose of antibiotic powder. This simple and effective method for
preparation of ALBCs can significantly improve the efficiency of
antibiotic release in ALBCs. Cite this article: Bone Joint Res 2014;3:246–51.
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Affiliation(s)
- Y H Chang
- Chang Gung Memorial Hospital, Department of Orthopaedic Surgery, 5 Fu-Shin St., Kweishan, Taoyuan, 333, Taiwan
| | - C L Tai
- Chang Gung University, Graduate Institute of Medical Mechatronics, Taoyuan, Taiwan
| | - H Y Hsu
- Chang Gung Memorial Hospital, Department of Orthopaedic Surgery, 5 Fu-Shin St., Kweishan, Taoyuan, 333, Taiwan
| | - P H Hsieh
- Chang Gung Memorial Hospital, Department of Orthopaedic Surgery, 5 Fu-Shin St., Kweishan, Taoyuan, 333, Taiwan
| | - M S Lee
- Chang Gung Memorial Hospital, Department of Orthopaedic Surgery, 5 Fu-Shin St., Kweishan, Taoyuan, 333, Taiwan
| | - S W N Ueng
- Chang Gung Memorial Hospital, Department of Orthopaedic Surgery, 5 Fu-Shin St., Kweishan, Taoyuan, 333, Taiwan
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22
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Romanò CL, Logoluso N, Meani E, Romanò D, De Vecchi E, Vassena C, Drago L. A comparative study of the use of bioactive glass S53P4 and antibiotic-loaded calcium-based bone substitutes in the treatment of chronic osteomyelitis: a retrospective comparative study. Bone Joint J 2014; 96-B:845-50. [PMID: 24891588 DOI: 10.1302/0301-620x.96b6.33014] [Citation(s) in RCA: 100] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The treatment of chronic osteomyelitis often includes surgical debridement and filling the resultant void with antibiotic-loaded polymethylmethacrylate cement, bone grafts or bone substitutes. Recently, the use of bioactive glass to treat bone defects in infections has been reported in a limited series of patients. However, no direct comparison between this biomaterial and antibiotic-loaded bone substitute has been performed. In this retrospective study, we compared the safety and efficacy of surgical debridement and local application of the bioactive glass S53P4 in a series of 27 patients affected by chronic osteomyelitis of the long bones (Group A) with two other series, treated respectively with an antibiotic-loaded hydroxyapatite and calcium sulphate compound (Group B; n = 27) or a mixture of tricalcium phosphate and an antibiotic-loaded demineralised bone matrix (Group C; n = 22). Systemic antibiotics were also used in all groups. After comparable periods of follow-up, the control of infection was similar in the three groups. In particular, 25 out of 27 (92.6%) patients of Group A, 24 out of 27 (88.9%) in Group B and 19 out of 22 (86.3%) in Group C showed no infection recurrence at means of 21.8 (12 to 36), 22.1 (12 to 36) and 21.5 (12 to 36) months follow-up, respectively, while Group A showed a reduced wound complication rate. Our results show that patients treated with a bioactive glass without local antibiotics achieved similar eradication of infection and less drainage than those treated with two different antibiotic-loaded calcium-based bone substitutes.
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Affiliation(s)
- C L Romanò
- IRCCS Galeazzi Orthopaedic Institute, Department of Reconstructive Surgery of Osteo-articular Infections, Via R Galeazzi, Milan, Italy
| | - N Logoluso
- IRCCS Galeazzi Orthopaedic Institute, Department of Reconstructive Surgery of Osteo-articular Infections, Via R Galeazzi, Milan, Italy
| | - E Meani
- G Pini Orthopaedic Institute, Department of Osteo articular Infections, Piazza Cardinal Ferrari, Milan, Italy
| | - D Romanò
- IRCCS Galeazzi Orthopaedic Institute, Department of Reconstructive Surgery of Osteo-articular Infections, Via R Galeazzi, Milan, Italy
| | - E De Vecchi
- IRCCS Galeazzi Orthopaedic Institute, Laboratory of Clinical Chemistry and Microbiology, Via R Galeazzi, Milan, Italy
| | - C Vassena
- IRCCS Galeazzi Orthopaedic Institute, Laboratory of Clinical Chemistry and Microbiology, Via R Galeazzi, Milan, Italy
| | - L Drago
- IRCCS Galeazzi Orthopaedic Institute, Laboratory of Clinical Chemistry and Microbiology, Via R Galeazzi, Milan, Italy
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23
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Kanakaris N, Gudipati S, Tosounidis T, Harwood P, Britten S, Giannoudis PV. The treatment of intramedullary osteomyelitis of the femur and tibia using the Reamer–Irrigator–Aspirator system and antibiotic cement rods. Bone Joint J 2014; 96-B:783-8. [DOI: 10.1302/0301-620x.96b6.32244] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Intramedullary infection in long bones represents a complex clinical challenge, with an increasing incidence due to the increasing use of intramedullary fixation. We report a prospective case series using an intramedullary reaming device, the Reamer–Irrigator–Aspirator (RIA) system, in association with antibiotic cement rods for the treatment of lower limb long bone infections. A total of 24 such patients, 16 men and eight women, with a mean age of 44.5 years (17 to 75), 14 with femoral and 10 with tibial infection, were treated in a staged manner over a period of 2.5 years in a single referral centre. Of these, 21 patients had had previous surgery, usually for fixation of a fracture (seven had sustained an open fracture originally and one had undergone fasciotomies). According to the Cierny–Mader classification system, 18 patients were classified as type 1A, four as 3A (discharging sinus tract), one as type 4A and one as type 1B. Staphylococcus species were isolated in 20 patients (83.3%). Local antibiotic delivery was used in the form of impregnated cement rods in 23 patients. These were removed at a mean of 2.6 months (1 to 5). Pathogen-specific antibiotics were administered systemically for a mean of six weeks (3 to 18). At a mean follow-up of 21 months (8 to 36), 23 patients (96%) had no evidence of recurrent infection. One underwent a planned trans-tibial amputation two weeks post-operatively due to peripheral vascular disease and chronic recalcitrant osteomyelitis of the tibia and foot. The combination of RIA reaming, the administration of systemic pathogen-specific antibiotics and local delivery using impregnated cement rods proved to be a safe and efficient form of treatment in these patients. Cite this article: Bone Joint J 2014; 96-B:783–8.
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Affiliation(s)
- N. Kanakaris
- Leeds Teaching Hospitals NHS Trust, Academic
Department of Trauma and Orthopaedics, Leeds
General Infirmary, Clarendon wing Level A, LS13EX, Leeds, UK
| | - S. Gudipati
- Leeds Teaching Hospitals NHS Trust, Academic
Department of Trauma and Orthopaedics, Leeds
General Infirmary, Clarendon wing Level A, LS13EX, Leeds, UK
| | - T. Tosounidis
- Leeds Teaching Hospitals NHS Trust, Academic
Department of Trauma and Orthopaedics, Leeds
General Infirmary, Clarendon wing Level A, LS13EX, Leeds, UK
| | - P. Harwood
- Leeds Teaching Hospitals NHS Trust, Academic
Department of Trauma and Orthopaedics, Leeds
General Infirmary, Clarendon wing Level A, LS13EX, Leeds, UK
| | - S. Britten
- Leeds Teaching Hospitals NHS Trust, Academic
Department of Trauma and Orthopaedics, Leeds
General Infirmary, Clarendon wing Level A, LS13EX, Leeds, UK
| | - P. V. Giannoudis
- University of Leeds, School
of Medicine, Academic Department of Trauma
and Orthopaedics, 21 Cricketers Fold, Shadwell, Leeds, LS17
8WE, UK
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Sanz-Ruiz P, Paz E, Abenojar J, Carlos del Real J, Vaquero J, Forriol F. Effects of vancomycin, cefazolin and test conditions on the wear behavior of bone cement. J Arthroplasty 2014; 29:16-22. [PMID: 23702270 DOI: 10.1016/j.arth.2013.04.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Revised: 04/08/2013] [Accepted: 04/11/2013] [Indexed: 02/01/2023] Open
Abstract
Antibiotic cement has been recommended in the treatment of prosthetic infections. The purpose of this study was to investigate the mechanical behavioral changes in cement loaded with two antibiotics, vancomycin and cefazolin, in dry and liquid medium. Six groups and four study conditions were established according to the doses of antibiotic used and the ageing (immersion in phosphate buffered saline) of the samples. Properties evaluated were friction coefficient and wear. Samples in dry medium showed higher wears than in liquid. Antibiotic selection did not influence wear properties tested in dry conditions, however, in liquid medium, there were higher frictional coefficients and wear for cefazolin loaded cement after one week and for vancomycin and cefazolin after one month. The results suggest that antibiotic cements behave differently in liquid and that the molecular characteristics of antibiotics are essential for determining this influence.
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Affiliation(s)
- Pablo Sanz-Ruiz
- Department of Traumatology and Orthopaedic Surgery, General University Hospital Gregorio Marañón, Madrid, Spain
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Sanz-Ruiz P, Paz E, Abenojar J, del Real J, Forriol F, Vaquero J. Influence of the physiological medium on the mechanical properties of bone cement: Can current studies be extrapolated? ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.recote.2014.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Sanz-Ruiz P, Paz E, Abenojar J, Del Real JC, Forriol F, Vaquero J. [Influence of the physiological medium on the mechanical properties of bone cement: can current studies be extrapolated?]. Rev Esp Cir Ortop Traumatol (Engl Ed) 2013; 58:3-10. [PMID: 24295826 DOI: 10.1016/j.recot.2013.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2013] [Accepted: 09/07/2013] [Indexed: 10/26/2022] Open
Abstract
PURPOSE The use of bone cement is widespread in orthopaedic surgery. Most of the mechanical tests are performed in dry medium, making it difficult to extrapolate the results. The objective of this study is to assess if the mechanical properties of polymethylmethacrylate (PMMA), obtained in previous reports, are still present in a liquid medium. MATERIAL AND METHOD An experimental study was designed with antibiotic (vancomycin) loaded PMMA. Four groups were defined according to the medium (dry or liquid) and the pre-conditioning in liquid medium (one week or one month). Wear and flexural strength tests were performed according to ASTM and ISO standards. Volumetric wear, friction coefficient, tensile strength, and Young's modulus were analyzed. All samples were examined by scanning electron microscopy. RESULTS The samples tested in liquid medium showed lower wear and flexural strength values (P<.05). The kind of wear was modified from abrasive to adhesive in those samples studied in liquid medium. The samples with a pre-conditioning time showed lower values of wear (P<.05). CONCLUSIONS Caution is recommended when extrapolating the results of previous PMMA results. The different mechanical strength of the cement in a liquid medium, observed in saline medium, is much closer to the clinical situation.
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Affiliation(s)
- P Sanz-Ruiz
- Servicio de Cirugía Ortopédica y Traumatología, Hospital General Universitario Gregorio Marañón, Madrid, España.
| | - E Paz
- Instituto para la investigación tecnológica, Departamento de ingeniería mecánica, Universidad Pontificia Comillas, Madrid, España
| | - J Abenojar
- Grupo desarrollo materiales, Departamento de ingeniería y ciencia de materiales, Universidad Carlos III, Madrid, España
| | - J C Del Real
- Instituto para la investigación tecnológica, Departamento de ingeniería mecánica, Universidad Pontificia Comillas, Madrid, España
| | - F Forriol
- Facultad de Medicina, Universidad San Pablo CEU, Madrid, España
| | - J Vaquero
- Servicio de Cirugía Ortopédica y Traumatología, Hospital General Universitario Gregorio Marañón, Madrid, España
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Chang Y, Tai CL, Hsieh PH, Ueng SWN. Gentamicin in bone cement: A potentially more effective prophylactic measure of infectionin joint arthroplasty. Bone Joint Res 2013; 2:220-6. [PMID: 24128666 PMCID: PMC3809714 DOI: 10.1302/2046-3758.210.2000188] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Objectives The objective of this study is to determine an optimal antibiotic-loaded
bone cement (ALBC) for infection prophylaxis in total joint arthroplasty
(TJA). Methods We evaluated the antibacterial effects of polymethylmethacrylate
(PMMA) bone cements loaded with vancomycin, teicoplanin, ceftazidime,
imipenem, piperacillin, gentamicin, and tobramycin against methicillin-sensitive Staphylococcus
aureus (MSSA), methicillin-resistant Staph. aureus (MRSA),
coagulase-negative staphylococci (CoNS), Escherichia
coli, Pseudomonas aeruginosa, and Klebsiella
pneumoniae. Standardised cement specimens made from 40 g
PMMA loaded with 1 g antibiotics were tested for elution characteristics,
antibacterial activities, and compressive strength in vitro. Results The ALBC containing gentamicin provided a much longer duration
of antibiotic release than those containing other antibiotic. Imipenem-loading
on the cement had a significant adverse effect on the compressive
strength of the ALBC, which made it insufficient for use in prosthesis
fixation. All of the tested antibiotics maintained their antibacterial
properties after being mixed with PMMA. The gentamicin-loaded ALBC
provided a broad antibacterial spectrum against all the test organisms
and had the greatest duration of antibacterial activity against
MSSA, CoNS, P. aeruginosa and E. coli. Conclusion When considering the use of ALBC as infection prophylaxis in
TJA, gentamicin-loaded ALBC may be a very effective choice. Cite this article: Bone Joint Res 2013;2:220–6.
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Affiliation(s)
- Y Chang
- Chang Gung Memorial Hospital, Departmentof Orthopaedic Surgery, 5 Fu-Hsing Street, Kweishan, Taoyuan, Taiwan
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28
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Isoniazid could be used for antibiotic-loaded bone cement for musculoskeletal tuberculosis: an in vitro study. Clin Orthop Relat Res 2013; 471:2400-6. [PMID: 23504536 PMCID: PMC3676586 DOI: 10.1007/s11999-013-2899-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Accepted: 02/25/2013] [Indexed: 01/31/2023]
Abstract
BACKGROUND Antibiotic-loaded bone cement (ALBC) has been used in serious cases of musculoskeletal tuberculosis, but the type and amount of antibiotic that should be used in ALBC have not been determined. QUESTIONS/PURPOSES We therefore determined the (1) elution characteristics and (2) antimycobacterial activity of isoniazid- and rifampicin-loaded bone cement. METHODS A total of 240 elution samples of each of three discs from 40 g bone cement mixed with one of eight dosages: 1 g, 2 g, and 4 g isoniazid, 1 g, 2 g, and 4 g rifampicin, and a combination of 1 + 1 g or 2 + 2 g of isoniazid and rifampicin. The polymerization of rifampicin-loaded bone cement was delayed to mean 122.5 ± 31.1 minutes. We measured the quantity of isoniazid and rifampicin and the antimycobacterial activity on Days 1, 3, 7, 14, and 30. RESULTS Isoniazid eluted in almost all the samples while rifampicin was detected only on Day 1 with 2 g (0.7 ± 0.4 ug/mL/day), and until Day 14 with 4 g (0.1 ± 0.0 ug/mL/day). Most of the samples containing isoniazid showed antimycobacterial activity while the samples containing rifampicin showed antimycobacterial activity only on Day 1 with 1 g (0.52 ± 0.18 ug/mL), until Day 14 with 2 g (0.03 ± 0.00 ug/mL), and until Day 30 with 4 g (1.84 ± 1.90 ug/mL). CONCLUSION Rifampicin was unsuitable for ALBC because of its delayed polymerization. Isoniazid eluted and showed antimycobacterial activity for 30 days. CLINICAL RELEVANCE The data suggest isoniazid could be considered for use in ALBC for musculoskeletal tuberculosis if used with systemic treatment. For preventing resistance and systemic toxicity, a combination with a second-line drug and an in vivo study would be needed.
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Zmistowski B, Parvizi J. Identification and treatment of infected total hip arthroplasty. Expert Rev Anti Infect Ther 2012; 10:509-18. [PMID: 22512759 DOI: 10.1586/eri.12.19] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Periprosthetic joint infection (PJI) in the hip following prosthetic joint placement is a devastating outcome of an otherwise often successful surgical treatment (total-hip arthroplasty). Management of PJI is dependent upon accurate diagnosis and successful treatment, both of which are challenging. Recently, great strides have been made in improving the diagnosis of PJI, which has no 'gold standard' diagnostic tool. Proper diagnosis is essential as untreated or undetected PJI can quickly lead to biofilm formation on the implant surface depending upon the infecting organism. Upon complete biofilm formation, successful treatment requires prosthetic resection with immediate or delayed reimplantation. Even with the most aggressive surgical treatment, PJI eradication currently has a success rate of approximately 80%. Unfortunately, technologies to improve the local delivery of antibiotics are not expected to be available in the near future.
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Affiliation(s)
- Benjamin Zmistowski
- The Rothman Institute of Orthopaedics at Thomas Jefferson University Hospital, 925 Chestnut Street, 5th Floor, Philadelphia, PA 19107, USA
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Hallan G, Espehaug B, Furnes O, Wangen H, Høl PJ, Ellison P, Havelin LI. Is there still a place for the cemented titanium femoral stem? 10,108 cases from the Norwegian Arthroplasty Register. Acta Orthop 2012; 83:1-6. [PMID: 22206445 PMCID: PMC3278649 DOI: 10.3109/17453674.2011.645194] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE Despite the fact that there have been some reports on poor performance, titanium femoral stems intended for cemented fixation are still used at some centers in Europe. In this population-based registry study, we examined the results of the most frequently used cemented titanium stem in Norway. PATIENTS AND METHODS 11,876 cases implanted with the cemented Titan stem were identified for the period 1987-2008. Hybrid arthroplasties were excluded, leaving 10,108 cases for this study. Stem survival and the influence of age, sex, stem offset and size, and femoral head size were evaluated using Cox regression analyses. Questionnaires were sent to the hospitals to determine the surgical technique used. RESULTS Male sex, high stem offset, and small stem size were found to be risk factors for stem revision, (adjusted RR = 2.5 (1.9-3.4), 3.3 (2.3-4.8), and 2.2 (1.4-3.5), respectively). Patients operated in the period 2001-2008 had an adjusted relative risk (RR) of 4.7 (95% CI: 3.0-7.4) for stem revision due to aseptic stem loosening compared to the period 1996-2000. Changes in broaching technique and cementing technique coincided with deterioration of the results in some hospitals. INTERPRETATION The increased use of small stem sizes and high-offset stems could only explain the deterioration of results to a certain degree since the year 2000. The influence of discrete changes in surgical technique over time could not be fully evaluated in this registry study. We suggest that this cemented titanium stem should be abandoned. The results of similar implants should be carefully evaluated.
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Affiliation(s)
- Geir Hallan
- Norwegian Arthroplasty Register, Department of Orthopedic Surgery, Haukeland University Hospital, Bergen
| | - Birgitte Espehaug
- Norwegian Arthroplasty Register, Department of Orthopedic Surgery, Haukeland University Hospital, Bergen
| | | | - Helge Wangen
- Department of Orthopedic Surgery, Innlandet Hospital Trust, Elverum
| | - Paul J Høl
- Department of Surgical Sciences, University of Bergen, Bergen, Norway
| | - Peter Ellison
- Department of Surgical Sciences, University of Bergen, Bergen, Norway
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Galasso O, Mariconda M, Calonego G, Gasparini G. Physical, mechanical and pharmacological properties of coloured bone cement with and without antibiotics. ACTA ACUST UNITED AC 2011; 93:1529-36. [DOI: 10.1302/0301-620x.93b11.26955] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Coloured bone cements have been introduced to make the removal of cement debris easier at the time of primary and revision joint replacement. We evaluated the physical, mechanical and pharmacological effects of adding methylene blue to bone cement with or without antibiotics (gentamicin, vancomycin or both). The addition of methylene blue to plain cement significantly decreased its mean setting time (570 seconds (sd 4) vs 775 seconds (sd 11), p = 0.01), mean compression strength (95.4 MPa (sd 3) vs 100.1 MPa (sd 6), p = 0.03), and mean bending strength (65.2 MPa (sd 5) vs 76.6 MPa (sd 4), p < 0.001) as well as its mean elastic modulus (2744 MPa (sd 97) vs 3281 MPa (sd 110), p < 0.001). The supplementation of the coloured cement with vancomycin and gentamicin decreased its mean bending resistance (55.7 MPa (sd 4) vs 65.2 MPa (sd 5), p < 0.001).The methylene blue significantly decreased the mean release of gentamicin alone (228.2 µg (sd 24) vs 385.5 µg (sd 26), p < 0.001) or in combination with vancomycin (498.5 µg (sd 70) vs 613 µg (sd 25), p = 0.018) from the bone cement. This study demonstrates several theoretical disadvantages of the antibiotic-loaded bone cement coloured with methylene blue.
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Affiliation(s)
- O. Galasso
- University Magna Graecia, Department
of Orthopaedic and Trauma Surgery, V.le Europa, Catanzaro
88100, Italy
| | - M. Mariconda
- University Federico II, Department
of Orthopaedic and Trauma Surgery, Via S. Pansini, 80131
Naples, Italy
| | - G. Calonego
- Tecres S.p.A., Via
A. Doria 6, Sommacampagna, 37066
Verona, Italy
| | - G. Gasparini
- University Magna Graecia, Department
of Orthopaedic and Trauma Surgery, V.le Europa, Catanzaro
88100, Italy
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Neut D, Kluin OS, Thompson J, van der Mei HC, Busscher HJ. Gentamicin release from commercially-available gentamicin-loaded PMMA bone cements in a prosthesis-related interfacial gap model and their antibacterial efficacy. BMC Musculoskelet Disord 2010; 11:258. [PMID: 21067595 PMCID: PMC2992479 DOI: 10.1186/1471-2474-11-258] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2010] [Accepted: 11/10/2010] [Indexed: 12/21/2022] Open
Abstract
Background Around about 1970, a gentamicin-loaded poly (methylmethacrylate) (PMMA) bone cement brand (Refobacin Palacos R) was introduced to control infection in joint arthroplasties. In 2005, this brand was replaced by two gentamicin-loaded follow-up brands, Refobacin Bone Cement R and Palacos R + G. In addition, another gentamicin-loaded cement brand, SmartSet GHV, was introduced in Europe in 2003. In the present study, we investigated differences in gentamicin release and the antibacterial efficacy of the eluent between these four cement brands. Methods 200 μm-wide gaps were made in samples of each cement and filled with buffer in order to measure the gentamicin release. Release kinetics were related to bone cement powder particle characteristics and wettabilities of the cement surfaces. Gaps were also inoculated with bacteria isolated from infected prostheses for 24 h and their survival determined. Gentamicin release and bacterial survival were statistically analysed using the Student's t-test. Results All three Palacos variants showed equal burst releases but each of the successor Palacos cements showed significantly higher sustained releases. SmartSet GHV showed a significantly higher burst release, while its sustained release was comparable with original Palacos. A gentamicin-sensitive bacterium did not survive in the high gentamicin concentrations in the interfacial gaps, while a gentamicin-resistant strain did, regardless of the type of cement used. Survival was independent of the level of burst release by the bone cement. Conclusions Although marketed as the original gentamicin-loaded Palacos cement, orthopaedic surgeons should be aware that the successor cements do not appear to have the same release characteristics as the original one. Overall, high gentamicin concentrations were reached inside our prosthesis-related interfacial gap model. These concentrations may be expected to effectively decontaminate the prosthesis-related interfacial gap directly after implantation, provided that these bacteria are sensitive for gentamicin.
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Affiliation(s)
- Daniëlle Neut
- Department of Biomedical Engineering, University Medical Center Groningen and University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands.
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Campoccia D, Montanaro L, Speziale P, Arciola CR. Antibiotic-loaded biomaterials and the risks for the spread of antibiotic resistance following their prophylactic and therapeutic clinical use. Biomaterials 2010; 31:6363-77. [DOI: 10.1016/j.biomaterials.2010.05.005] [Citation(s) in RCA: 300] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2010] [Accepted: 05/07/2010] [Indexed: 12/28/2022]
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Johannsson B, Taylor J, Clark CR, Shamsuddin H, Beekmann SE, Polgreen P. Treatment approaches to prosthetic joint infections: results of an Emerging Infections Network survey. Diagn Microbiol Infect Dis 2010; 66:16-23. [DOI: 10.1016/j.diagmicrobio.2009.08.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2009] [Revised: 08/20/2009] [Accepted: 08/21/2009] [Indexed: 10/20/2022]
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Urabe K, Naruse K, Hattori H, Hirano M, Uchida K, Onuma K, Park HJ, Itoman M. In vitro comparison of elution characteristics of vancomycin from calcium phosphate cement and polymethylmethacrylate. J Orthop Sci 2009; 14:784-93. [PMID: 19997827 DOI: 10.1007/s00776-009-1397-9] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2009] [Accepted: 07/29/2009] [Indexed: 11/29/2022]
Abstract
BACKGROUND Calcium phosphate cement [CPC (Biopex)] has been used as the drug delivery system of choice for treatment of infected joint replacement because of its good elution efficiency. The influence of CPC polymerization on the bactericidal activity of vancomycin (VCM) impregnated into CPC has not been investigated. We compared VCM concentration, bactericidal activity, and profile of eluates between CPC and polymethylmethacrylate (PMMA; Cemex RX). METHODS Test specimens consisted of a powder composite of CPC or PMMA, VCM and solvent (10:0.25:3.3 g). Each test specimen was immersed in sterile phosphate-buffered saline. Eluates obtained on days 1, 3, 7, and 14 and weeks 4, 8, and 12 were evaluated by high performance liquid chromatography (HPLC) and by microbiological assay (MBA). RESULTS The elution level of VCM from CPC/VCM on day 1 was 8.1 fold greater than that from PMMA/VCM. The detection periods of VCM from CPC/VCM and PMMA/VCM were 8 weeks and 14 days, respectively. The values of eluates from CPC/VCM and PMMA/VCM obtained by HPLC were comparable to those obtained by MBA. HPLC chromatogram showed that the elution profiles of VCM from CPC/VCM and PMMA/VCM on day 1 were very close to those of standard solutions. CONCLUSIONS CPC could release more VCM over a longer period than PMMA. The polymerization of CPC and PMMA did not alter the inhibitory activity of VCM and did not denature VCM.
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Affiliation(s)
- Ken Urabe
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, Sagamihara, Kanagawa 228-8555, Japan
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Anagnostakos K, Kelm J. Enhancement of antibiotic elution from acrylic bone cement. J Biomed Mater Res B Appl Biomater 2009; 90:467-75. [PMID: 19145626 DOI: 10.1002/jbm.b.31281] [Citation(s) in RCA: 105] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Antibiotic-loaded acrylic bone cement is a well-established tool in the prophylaxis and treatment of orthopedic infections. Numerous studies about its pharmacokinetic properties have demonstrated that only a small part of the incorporated antibiotic amounts can be released, mostly over the first 8-10 weeks. Therefore, in the past 10 years, several attempts have been made for enhancement of the drug elution from bone cement. This article reviews this experience and pays special attention on biantibiotic combinations, additives other than antimicrobial agents, as well as the effect of ultrasound on the antibiotic elution characteristics.
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Affiliation(s)
- Konstantinos Anagnostakos
- Klinik für Orthopädie und Orthopädische Chirurgie, Universität des Saarlandes, Homburg/Saar, Germany. )
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Lewis G. Properties of antibiotic‐loaded acrylic bone cements for use in cemented arthroplasties: A state‐of‐the‐art review. J Biomed Mater Res B Appl Biomater 2008; 89:558-574. [DOI: 10.1002/jbm.b.31220] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Gladius Lewis
- Department of Mechanical Engineering, The University of Memphis, Memphis, Tennessee 38152
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