Orthopaedic bone cement

Abstract

Bone cements produced by different manufacturers vary in their mechanical properties and antibiotic elution characteristics. Small changes in the formulation of a bone cement, which may not be apparent to surgeons, can also affect these properties. The supplier of Palacos bone cement with added gentamicin changed in 2005. We carried out a study to examine the mechanical characteristics and antibiotic elution of Schering-Plough Palacos, Heraeus Palacos and Depuy CMW Smartset bone cements. Both Heraeus Palacos and Smartset bone cements performed significantly better than Schering-Plough Palacos in terms of mechanical characteristics, with and without additional vancomycin (p < 0.001). All cements show a deterioration in flexural strength with increasing addition of vancomycin, albeit staying above ISO minimum levels. Both Heraeus Palacos and Smartset elute significantly more gentamicin cumulatively than Schering-Plough Palacos. Smartset elutes significantly more vancomycin cumulatively than Heraeus Palacos. The improved antibiotic elution characteristics of Smartset and Heraeus Palacos are not associated with a deterioration in mechanical properties. Although marketed as the 'original' Palacos, Heraeus Palacos has significantly altered mechanical and antibiotic elution characteristics compared with the most commonly-used previous version.

Elution and Mechanical Strength of Vancomycin-Loaded Bone Cement: In Vitro Study of the Influence of Brand Combination

“…There are some significant differences in the mechanical strength of different brands of bone cement, but these differences are small compared with other factors, such as temperature, fat, or blood in the cement [10]. In general, the mechanical strength used for definite fixation of prosthesis must have ultimate compression strength of more than 70MPa as described by international industrial standard [9, 43]. In our study, the compression strength of high dose ALBCs after elution does not exceed 70MPa in Lyo-Vancin and Strerile Vancomycin groups, regardless of the brands of PMMA used.…”

Bone cement product and failure in total knee arthroplasty

“…(2008) performed an in vitro study comparing Palacos with gentamicin with the cements Palacos R + G and SmartSet GHV. All cements performed well, with minor differences.…”

“…This explanation was also suggested by an official statement from Heraeus Kulzer, given in Bridgens et al. (2008). Furthermore, a legal dispute between Heraeus Medical Nordic and Biomet at the Norwegian Complaints Board for Public Procurement regarding the procurement of cement has indicated that the suppliers of antibiotics and monomers, and also production methods, do actually vary to some extent between the old and new products (KOFA 2011).…”

“…For example, several of the studies referred to suggest a possibly higher gentamicin release from the bone cements that are currently on the market (Bridgens et al. 2008, Neut et al. 2010).…”

“…Then, in 2005, Heraeus Kulzer decided to self-distribute the bone cement end-product to all territories, and the well-known products Palacos with gentamicin and Refobacin Palacos R were removed from the market (Bridgens et al. 2008, Neut et al. 2010).…”