How do porosity-inducing techniques affect antibiotic elution from bone cement? An in vitro comparison between hydrogen peroxide and a mechanical mixer

Abstract

BackgroundIncreasing the porosity of an antibiotic-loaded cement spacer increases the antibiotic elution, but the correlation between porosity and antibiotic elution is not well documented. The purposes of this study was to attempt new porosity-increasing methods and to investigate the correlation between antibiotic elution and both total and surface porosity.Materials and methodsFive types of antibiotic-loaded bone cement (ALBC) using 2 g cefazolin and 40 g cement were prepared. Other than manual mixing, hydrogen peroxide was used as a foaming agent and a mixing drill piece was used as a mechanical device to try to induce porosity when mixing the cement. Elution of antibiotic into phosphate-buffered saline was measured from 1 h to 1 week. Surface porosity was calculated from density values which were measured with a density kit and an electronic balance, while total porosity was quantified using micro-computed tomography.ResultsWhen a mixing drill piece was used to induce porosity, we observed a significant increasin antibiotic elution compared to a manually mixed ALBC. On the other hand, hydrogen peroxide reduced the elution significantly. Mild correlation between the total amount of cluted in 1 week antibiotic elution and total porosity was observed.ConclusionsIn terms of improving elution, the mixing drill piece seemed to be efficient. A relationship between surface porosity and elution efficacy was not observed.

The Effects of Different Mixing Speeds on the Elution and Strength of High-Dose Antibiotic-Loaded Bone Cement Created With the Hand-Mixed Technique

“…Therefore, bone cement that is prepared by hand mixing can exhibit greater antibiotic elution. Many studies have used porogens to increase the porosity of bone cement and antibiotic elution [7][8][9][10][11][12][13][14]. McLaren et al reported that the elution of antibiotic from ALBC can be increased via the use of space fillers such as xylitol, glycine, sucrose, and erythritol [12,13].…”

“…Many studies have reported that increasing the porosity of ALBC can increase antibiotic elution [7,8]. Therefore, dextran [9], hydrogen peroxide (H 2 O 2 ) [10], calcium sulfate (CaSO 4 ) [11], sucrose [12], xylitol [12], and glycine [13] have been used as porogens or space fillers to obtain more porous ALBC. Additionally, the porosity of PMMA can be increased up to 10% via the use of high-speed of hand mixing [14,15].…”

Antibiotic release and antibacterial efficacy in cement spacers and cement beads impregnated with different techniques: In vitro study

“…Palacos is known to exhibit more efficient antibiotics elution compared to other cement types. [7,9,[26][27][28] Tabromycin and vancomycin release is documented to be significantly higher with Palacos compared to CMW 1 and CMW 3. [27] There is no such established difference between Simplex P and CMW 3.…”

Evaluation of Elution and Mechanical Properties of Two Injectable Chemotherapeutic Bone Cements

“…the type of bone cement used, the choice of drug [13,14,15,16], the form of drug (e.g. powder vs. crystalline) [17,18], the drug’s chemical compatibility with the bone cement, the optimal initial amount of the chemotherapy drug added, changes in the mechanical property of the bone cement, the optimal mixing method [19], etc. In general, drug elution from bone cements is either incomplete or not ideal.…”