Mechanical characteristics of antibiotic-laden bone cement

Abstract

We studied the mechanical characteristics of cement-antibiotic combinations in vitro. Palacos R was tested without antibiotics, with gentamicin alone and with gentamicin plus vancomycin or flucloxacillin. Palacos LV was studied only with gentamicin added. CMW 1 was studied with gentamicin added, with gentamicin plus vancomycin, and with gentamicin plus flucloxacillin. We performed four-point bending tests on beams of cement to establish bending strength and modulus, and compared the values to ISO standards. Density was also assessed. Palacos R was the strongest of the cements (bending strength 80 MPa). Palacos formulations (apart from Palacos LV) had a higher density and bending modulus than CMW 1. Statistical comparison of various cements with plain Palacos R showed lower density in 4 of the mixtures, and lower bending strength and modulus in 6 of the mixtures. Palacos R/gentamicin plus vancomycin and CMW 1/gentamicin plus vancomycin had bending strength slightly above minimum ISO standards, suggesting that the addition of vancomycin during cement mixing may compromise the outcome in revision surgery for sepsis.

Mechanical effects of the use of vancomycin and meropenem in acrylic bone cement

“…ably little reduction in the mechanical behavior of 1.25 VA cement and 1.25 VA + 1.25 ME cement in comparison with the control, 2.5 VA cement showed reduced bending and fatigue strength compared to the control cement. Our findings regarding the reduced bending strength are consistent with those of a previous study (Armstrong et al 2002). Previous studies of the fatigue properties of PMMA containing antibiotics are contradictory: sometimes no significant reduction in fatigue strength has been found after adding gentamicin or erythromycin and colistin (Davies et al 1989, Baleani et al 2003 or tobramycin (Davies and Harris 1991), while in other cases a significant reduction in fatigue strength has been found after adding gentamicin (Schurman et al 1978, Davies et al 1989 or vancomycin (Klekamp et al 1999).…”

“…In particular, fatigue strength is important, since it can play a role in long-term failure of cemented implants (Topoleski et al 1990, Lewis 2003. However, antibiotics may impair the mechanical behavior of the cement (Klekamp et al 1999, Armstrong et al 2002. Furthermore, the increasing resistance of periprosthetic bacteria to commonly used antibiotics, such as gentamicin and tobramycin, is an emerging problem (Neu 1992, Tunney et al 1998.…”

Bone tissue engineering therapeutics: controlled drug delivery in three-dimensional scaffolds

“…However, PMMA is not a resorbable polymer and must be removed in a second surgical procedure (Vallet-Regí et al 2007;Shi et al 2009). In this context, it should be pointed out that most previous work on loading biomaterials with antibiotics for orthopaedic applications has been carried out on bone-filler materials and bone cements (Takechi et al 1998;Armstrong et al 2002;Diez-Peñ a et al 2002;Gbureck et al 2002;Joseph et al 2003;Hanssen 2004;Joosten et al 2004;Webb et al 2005;Schnieders et al 2006;Krasko et al 2007;Zilberman & Elsner 2008). In one of the first attempts to develop multifunctional re-absorbable implants, Queiroz et al (2001) prepared sodium ampicillin which was adsorbed onto HA and glass-reinforced HA composites as a potential pharmaceutical formulation for periodontitis.…”

The effect of vancomycin addition to the compression strength of antibiotic-loaded bone cements

“…Vancomycin has been the most commonly used agent for intravenous treatment in infected arthroplasties caused by resistant strains [3], and it was therefore also used as an additive to bone cement in revision surgery [1]. Combining an aminoglycoside with vancomycin in bone cement for revision cases of infected implants is common in surgical practice [9,22].…”