Backgrounds of antibiotic-loaded bone cement and prosthesis-related infection

Hendriks, Johannes G.E.; Horn, J.R. van; Mei, Henny C. van der; Busscher, Henk J.

doi:10.1016/s0142-9612(03)00554-4

Cited by 263 publications

(188 citation statements)

References 127 publications

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“…The infection rate ranges between 0.5% and 3.0% after primary total hip arthroplasty despite strict antiseptic operative procedures, including systemic prophylaxis [1][2][3][4][5][6]. Infection rates between 5% and 35% have been described for endoprosthetic replacement of large bone defects after tumor resection [7][8][9][10][11][12], while external fixation produced infection in 2-30% of cases found during a literature review [13][14][15][16][17].…”

Section: Introductionmentioning

confidence: 99%

Antibacterial iodine-supported titanium implants

et al. 2011

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Deep infection remains a serious complication in orthopedic implant surgery. In order to reduce the incidence of implant-associated infections, several biomaterial surface treatments have been proposed. This study focused on evaluating the antibacterial activity of iodine-supported titanium (Ti-I 2 ) and impact on post-implant infection, as well as determining the potential suitability of Ti-I 2 as a biomaterial.External fixation pins were used in this experiment as trial implants because it was easy to make the septic models.The antibacterial activity of the metal was measured using a modification of the Japanese Industrial Standards method. Activity was evaluated by exposing the implants to Staphylococcus aureus or Escherichia coli and comparing reaction of pathogens to the Ti-I 2 versus the stainless steel and titanium controls. The Ti-I 2 clearly inhibited bacterial colonization more than the control metals. In addition, cytocompatibility was assessed by counting the number of colonies that formed on the metals. The three metals showed the same amount of fibroblast colony formation.Japanese white rabbits were used as an in vivo model. Three pins were inserted into both femora of six rabbits for histological analysis. Pin sites were inspected and graded for infection and inflammation. Fewer signs of infection and inflammatory changes were observed in conjunction with the Ti-I 2 pins. Furthermore, osteoconductivity of the implant was evaluated with osteoid formation surface of the pin. Consecutive bone formation was observed around the Ti-I 2 and titanium pins, while little osteoid formation was found around the stainless steel pins. These findings suggest that Ti-I 2 has antimicrobial activity and cytocompatibility.Therefore, Ti-I 2 substantially reduces the incidence of implant infection and shows particular promise as a biomaterial.

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Section: Introductionmentioning

confidence: 99%

Antibacterial iodine-supported titanium implants

et al. 2011

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“…All scale bars = 100µm DISCUSSION Both methods of testing show an increase in the fatigue life for Refobacin® Plus Bone Cement compared to Refobacin® Bone Cement and Refobacin Palacos® R. These are different formulation cements with Refobacin® Plus Bone Cement and Palamed® G having a higher powder-toliquid ratio and lower zirconium dioxide content than the other pair of cements ( Table 1). The antibiotic content is similar in the four cements and although these levels of antibiotic are clinically effective [23,24] they are not thought to significantly affect the mechanical properties of the cement [22,25]. Only the SSR specimens indicate an increase in the fatigue life for Palamed® G compared to Refobacin® Bone Cement R and Refobacin Palacos® R and no significant difference between Refobacin® Plus Bone Cement and Palamed® G. The Wöhler analysis using the MSC specimens shows an increase over all the stress levels for Refobacin® Plus Bone Cement compared to the Refobacin® Bone Cement R and Refobacin Palacos® R, with no substantial differences seen between the Palamed® G and the other two cements.…”

Section: Density Measurementsmentioning

confidence: 86%

Comparison of two methods of fatigue testing bone cement

et al. 2010

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Two different methods have been used to fatigue test four bone cements. Each method has been used previously, but the results have not been compared. One method tests at least 10 samples over a single stress range in tension only and uses Weibull analysis to calculate the median number of cycles to failure and the Weibull modulus. The second test regime uses fewer specimens at various stress levels tested in fully reversed tension-compression, and generates a stress versus number of cycles to failure (S-N) or Wöhler curve. Data from specimens where the fracture surface contains pores greater than 1mm across is rejected. The single stress level test is quicker to perform however, provides only tensile fatigue data, but the material tested includes pores, thus more physiological cement is tested. The multiple stress level testing regime uses combined tension and compression loading and multiple stress levels, thus more physiological loading, but excludes specimens where the defects are greater than 1mm across, so is less representative of cement in vivo. The fatigue lives between the cements were up to a factor 15 different for the single stress level tension only tests, while they were only a factor of 2 different in the fully reversed tension-compression testing. The single stress level results are more effected by surface flaws, thus the differences found using the multiple stress levels are more indicative of differences in the fatigue lives of the cements. However, the single stress level tests are quicker, so are useful for initial screening.

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“…It is interesting that the addition of such substances to the bone recipe has been overlooked in the literature, even though many commercial bone recipe kits include co-polymers in their formulation (Hendriks et al, 2004). Comonomers may be added in small amount to the reaction medium in order to enhance the polymerization rates and the gel effect, thus accelerating the bone cement curing process.…”

Section: Verified That It Is Verymentioning

confidence: 99%

“…Besides, when initiator is added to the mixture, polymer chains that constitute the PMMA powder participate in the free radical polymerization reactions, forming entanglements with newly formed chains. This leads to an intimate chemical connection between the new and the previously formed PMMA chains (Hendriks et al, 2004). Since then, the term bone cement has been used to designate PMMA and methyl methacrylate (MMA) based mixtures (and mixtures with other acrylate compounds), prepared in the presence of initiators.…”

Section: Introductionmentioning

confidence: 99%

Production of bone cement composites: effect of fillers, co-monomer and particles properties

Santos¹,

Pita²,

Melo³

et al. 2011

Braz. J. Chem. Eng.

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-Artificial bone cements (BCs) based on poly(methyl methacrylate) (PMMA) powders and methyl methacrylate (MMA) liquid monomer also present in their formulation small amounts of other substances, including a chemical initiator compound and radiopaque agents. Because inadequate mixing of the recipe components during the manufacture of the bone cement may compromise the mechanical properties of the final pieces, new techniques to incorporate the fillers into the BC and their effect upon the mechanical properties of BC pieces were investigated in the present study. PMMA powder composites were produced insitu in the reaction vessel by addition of X-ray contrasts to the reacting MMA mixture. It is shown that this can lead to much better mechanical properties of test pieces, when compared to standard bone cement formulations, because enhanced dispersion of the radiopaque agents can be achieved. Moreover, it is shown that the addition of hydroxyapatite (HA) and acrylic acid (AA) to the bone cement recipe can be beneficial for the mechanical performance of the final material. It is also shown that particle morphology can exert a tremendous effect upon the performance of test pieces, indicating that the suspension polymerization step should be carefully controlled when optimization of the bone cement formulation is desired.

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Backgrounds of antibiotic-loaded bone cement and prosthesis-related infection

Cited by 263 publications

References 127 publications

Antibacterial iodine-supported titanium implants

Antibacterial iodine-supported titanium implants

Comparison of two methods of fatigue testing bone cement

Production of bone cement composites: effect of fillers, co-monomer and particles properties

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