Advertisement

International Orthopaedics

, Volume 42, Issue 11, pp 2627–2632 | Cite as

Altering polymerization temperature of antibiotic-laden cement can increase porosity and subsequent antibiotic elution

  • Jeffrey Sundblad
  • Mary Nixon
  • Nancy Jackson
  • Rahul Vaidya
  • David Markel
Original Paper
  • 42 Downloads

Abstract

Purpose

To examine the role of polymerization temperature on the cement porosity and antibiotic elution to optimize antibiotic release from antibiotic-laden cement (ABLC).

Methods

Elution profiles of vancomycin and tobramycin from ABLC discs prepared with low- and high-dose antibiotic dosages, cured at 8, 21, and 37 °C, and placed in phosphate buffered saline (PBS) at 37 °C were examined. Samples were collected at one, four, eight, 24, 72, 168, 336, and 1008 hours to calculate the quantity of antibiotic eluted. Porosity was determined by MicroCT analysis.

Results

ABLC porosity and antibiotic elution were increased up to five times the amount eluted from room temperature discs (p < 0.05). Low-dose ABLC group saw decreased but similar porosity at 8 °C and 21 °C compared to cement cured at 37 °C (p < 0.001). High-dose ABLC group porosities were all significantly different (p < 0.02).

Conclusions

Altering the polymerization temperature of ABLC led to more porous constructs yielding increased antibiotic elution.

Keywords

Antibiotic cement Porosity Elution Vancomycin Tobramycin 

Notes

Author contributions

R. Vaidya: Research Institutional Funding Pfizer; Editorial/Governing Board Journal of Orthopedics and Traumatology; Board/Committee Member, Orthopedic Trauma Association; Intellectual Property Bonsetter Solutions LLC.

D. Markel: research funding, Stryker, OREF, and VA; consulting royalties, Stryker; reviewer/editorial board, JBJS, Journal of Arthroplasty, CORR, Arthroplasty Today; holds stock in CORE and Arboretum Ventures.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain studies with human or animal participants.

References

  1. 1.
    Conway J, Mansour J, Kotze K, Specht S, Shabtai L (2014) Antibiotic cement-coated rods: an effective treatment for infected long bones and prosthetic joint nonunions. Bone Joint J 96-B(10):1349–1354.  https://doi.org/10.1302/0301-620X.96B10.33799 CrossRefPubMedGoogle Scholar
  2. 2.
    Vrabec G, Stevenson W, Elguizaoui S, Kirsch M, Pinkowski J (2016) What is the intraarticular concentration of tobramycin using low-dose tobramycin bone cement in TKA: an in vivo analysis? Clin Orthop Relat Res 474(11):2441–2447.  https://doi.org/10.1007/s11999-016-5006-x CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Masri BA, Duncan CP, Beauchamp CP (1998) Long-term elution of antibiotics from bone-cement: an in vivo study using the prosthesis of antibiotic-loaded acrylic cement (PROSTALAC) system. J Arthroplasty 13(3):331–338CrossRefGoogle Scholar
  4. 4.
    Rousset M, Walle M, Cambou L, Mansour M, Samba A, Pereira B, Ghanem I, Canavese F (2018) Chronic infection and infected non-union of the long bones in paediatric patients: preliminary results of bone versus beta-tricalcium phosphate grafting after induced membrane formation. Int Orthop 42(2):385–393.  https://doi.org/10.1007/s00264-017-3693-x CrossRefPubMedGoogle Scholar
  5. 5.
    Sprowson AP, Jensen C, Chambers S, Parsons NR, Aradhyula NM, Carluke I, Inman D, Reed MR (2016) The use of high-dose dual-impregnated antibiotic-laden cement with hemiarthroplasty for the treatment of a fracture of the hip: the fractured hip infection trial. Bone Joint J 98-B(11):1534–1541.  https://doi.org/10.1302/0301-620X.98B11.34693 CrossRefPubMedGoogle Scholar
  6. 6.
    Joseph TN, Chen AL, Di Cesare PE (2003) Use of antibiotic-impregnated cement in total joint arthroplasty. J Am Acad Orthop Surg 11(1):38–47CrossRefGoogle Scholar
  7. 7.
    Anagnostakos K, Kelm J (2009) Enhancement of antibiotic elution from acrylic bone cement. J Biomed Mater Res B Appl Biomater 90(1):467–475.  https://doi.org/10.1002/jbm.b.31281 CrossRefPubMedGoogle Scholar
  8. 8.
    Amin TJ, Lamping JW, Hendricks KJ, McIff TE (2012) Increasing the elution of vancomycin from high-dose antibiotic-loaded bone cement: a novel preparation technique. J Bone Joint Surg Am 94(21):1946–1951.  https://doi.org/10.2106/JBJS.L.00014 CrossRefPubMedGoogle Scholar
  9. 9.
    Tai CL, Tsai SL, Chang YH, Hsieh PH (2011) Study the effect of polymerization temperature in the release of antibiotic from bone cement. Biomed Mater Eng 21(5–6):341–346.  https://doi.org/10.3233/BME-2012-0681 CrossRefPubMedGoogle Scholar
  10. 10.
    Shiramizu K, Lovric V, Leung A, Walsh WR (2008) How do porosity-inducing techniques affect antibiotic elution from bone cement? An in vitro comparison between hydrogen peroxide and a mechanical mixer. J Orthop Traumatol 9(1):17–22.  https://doi.org/10.1007/s10195-008-0099-y CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Pithankuakul K, Samranvedhya W, Visutipol B, Rojviroj S (2015) The effects of different mixing speeds on the elution and strength of high-dose antibiotic-loaded bone cement created with the hand-mixed technique. J Arthroplast 30(5):858–863.  https://doi.org/10.1016/j.arth.2014.12.003 CrossRefGoogle Scholar
  12. 12.
    van de Belt H, Neut D, Uges DR, Schenk W, van Horn JR, van der Mei HC, Busscher HJ (2000) Surface roughness, porosity and wettability of gentamicin-loaded bone cements and their antibiotic release. Biomaterials 21(19):1981–1987CrossRefGoogle Scholar
  13. 13.
    McLaren AC, Nelson CL, McLaren SG, De CGR (2004) The effect of glycine filler on the elution rate of gentamicin from acrylic bone cement: a pilot study. Clin Orthop Relat Res 427:25–27CrossRefGoogle Scholar
  14. 14.
    Neut D, van de Belt H, van Horn JR, van der Mei HC, Busscher HJ (2003) The effect of mixing on gentamicin release from polymethylmethacrylate bone cements. Acta Orthop Scand 74(6):670–676.  https://doi.org/10.1080/00016470310018180 CrossRefPubMedGoogle Scholar
  15. 15.
    Penner MJ, Masri BA, Duncan CP (1996) Elution characteristics of vancomycin and tobramycin combined in acrylic bone-cement. J Arthroplast 11(8):939–944CrossRefGoogle Scholar
  16. 16.
    Bridgens J, Davies S, Tilley L, Norman P, Stockley I (2008) Orthopaedic bone cement: do we know what we are using? J Bone Joint Surg Br 90(5):643–647.  https://doi.org/10.1302/0301-620X.90B5.19803 CrossRefPubMedGoogle Scholar
  17. 17.
    Pelletier MH, Lau AC, Smitham PJ, Nielsen G, Walsh WR (2010) Pore distribution and material properties of bone cement cured at different temperatures. Acta Biomater 6(3):886–891.  https://doi.org/10.1016/j.actbio.2009.09.016 CrossRefPubMedGoogle Scholar
  18. 18.
    Parks ML, Walsh HA, Salvati EA, Li S (1998) Effect of increasing temperature on the properties of four bone cements. Clin Orthop Relat Res 355:238–248CrossRefGoogle Scholar
  19. 19.
    Wixson RL (1992) Do we need to vacuum mix or centrifuge cement? Clin Orthop Relat Res (285):84-90Google Scholar
  20. 20.
    Wang JS, Toksvig-Larsen S, Muller-Wille P, Franzen H (1996) Is there any difference between vacuum mixing systems in reducing bone cement porosity? J Biomed Mater Res 33(2):115–119.  https://doi.org/10.1002/(SICI)1097-4636(199622)33:2&lt;115:AID-JBM8&gt;3.0.CO;2-U
  21. 21.
    Springer BD, Lee GC, Osmon D, Haidukewych GJ, Hanssen AD, Jacofsky DJ (2004) Systemic safety of high-dose antibiotic-loaded cement spacers after resection of an infected total knee arthroplasty. Clin Orthop Relat Res 427:47–51CrossRefGoogle Scholar
  22. 22.
    Mounasamy V, Fulco P, Desai P, Adelaar R, Bearman G (2013) The successful use of vancomycin-impregnated cement beads in a patient with vancomycin systemic toxicity: a case report with review of literature. Eur J Orthop Surg Traumatol 23(Suppl 2):S299–S302.  https://doi.org/10.1007/s00590-012-1062-4 CrossRefPubMedGoogle Scholar
  23. 23.
    Menge TJ, Koethe JR, Jenkins CA, Wright PW, Shinar AA, Miller GG, Holt GE (2012) Acute kidney injury after placement of an antibiotic-impregnated cement spacer during revision total knee arthroplasty. J Arthroplast 27 (6):1221–1227 e1221–1222. doi: https://doi.org/10.1016/j.arth.2011.12.005 CrossRefGoogle Scholar
  24. 24.
    Faschingbauer M, Reichel H, Bieger R, Kappe T (2015) Mechanical complications with one hundred and thirty eight (antibiotic-laden) cement spacers in the treatment of periprosthetic infection after total hip arthroplasty. Int Orthop 39(5):989–994.  https://doi.org/10.1007/s00264-014-2636-z CrossRefPubMedGoogle Scholar
  25. 25.
    Sterling GJ, Crawford S, Potter JH, Koerbin G, Crawford R (2003) The pharmacokinetics of simplex-tobramycin bone cement. J Bone Joint Surg Br 85(5):646–649CrossRefGoogle Scholar

Copyright information

© SICOT aisbl 2018

Authors and Affiliations

  1. 1.NeenahUSA
  2. 2.DetroitUSA
  3. 3.Ascension St. John ProvidenceSouthfieldUSA
  4. 4.NoviUSA

Personalised recommendations