Document Detail

Increasing the elution of vancomycin from high-dose antibiotic-loaded bone cement: a novel preparation technique.
MedLine Citation:
PMID:  23014891     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Antibiotic bone cement is commonly used in staged revision arthroplasty as well as the treatment of open fractures. Multiple factors affect antibiotic elution from bone cement. This study was performed to investigate the effect of two variables, the quantity of liquid monomer and the timing of antibiotic addition, on the ultimate elution of antibiotic from bone cement.
METHODS: Vancomycin-loaded Simplex P and SmartSet MV bone cement was prepared with three different methods: a common surgical technique, a mixing technique that doubled the amount of liquid monomer, and a novel technique that delayed antibiotic addition until after thirty seconds of polymerization. Cylinders of a standardized size were created from each preparation. The elution profiles of five cylinders from each preparation were measured over six weeks with use of high-performance liquid chromatography. Cylinders were tested in compression to quantify strength.
RESULTS: Delayed antibiotic addition resulted in significantly greater cumulative elution over six weeks (p < 0.0001), with minimal reduction in strength, compared with the other groups. Doubling the liquid monomer significantly reduced cumulative elution over six weeks compared with either of the other techniques (p < 0.0001). Vancomycin elution from Simplex P was 52%greater and vancomycin elution from SmartSet MV was 25% greater in the delayed-antibiotic-addition groups than it was in the corresponding standard surgical technique groups. The majority of the antibiotic was released over the first week in all groups. : High-dose-antibiotic bone cement prepared with delayed antibiotic addition increased vancomycin elution compared with the standard surgical preparation. Incorporating additional liquid monomer decreased vancomycin elution from high-dose-antibiotic cement. We recommend preparing high-dose-antibiotic bone cement with the delayed-antibiotic addition technique and not incorporating additional liquid monomer.
CLINICAL RELEVANCE: Both the relative volume of liquid monomer and the timing of antibiotic addition have substantial effects on the elution of antibiotic from bone cement.
Tanay J Amin; Jeffery W Lamping; Kelly J Hendricks; Terence E McIff
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Journal of bone and joint surgery. American volume     Volume:  94     ISSN:  1535-1386     ISO Abbreviation:  J Bone Joint Surg Am     Publication Date:  2012 Nov 
Date Detail:
Created Date:  2013-01-22     Completed Date:  2013-01-25     Revised Date:  2013-03-21    
Medline Journal Info:
Nlm Unique ID:  0014030     Medline TA:  J Bone Joint Surg Am     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1946-51     Citation Subset:  AIM; IM    
Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA.
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MeSH Terms
Anti-Bacterial Agents / pharmacokinetics*
Bone Cements / chemistry*
Chromatography, High Pressure Liquid
Compressive Strength
Polymethyl Methacrylate
Prosthesis Design
Time Factors
Vancomycin / pharmacokinetics*
Reg. No./Substance:
0/Anti-Bacterial Agents; 0/Bone Cements; 1404-90-6/Vancomycin; 80-62-6/Methylmethacrylate; 9011-14-7/Polymethyl Methacrylate
Comment In:
J Bone Joint Surg Am. 2012 Nov 7;94(21):e163   [PMID:  23014952 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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