Clinical Orthopaedics and Related Research®

, Volume 468, Issue 8, pp 2092–2100 | Cite as

An Approach for Determining Antibiotic Loading for a Physician-directed Antibiotic-loaded PMMA Bone Cement Formulation

  • Gladius Lewis
  • Jennifer L. BrooksEmail author
  • Harry S. Courtney
  • Yuan Li
  • Warren O. Haggard
Symposium: Papers Presented at the 2009 Meeting of the Musculoskeletal Infection Society



When a physician-directed antibiotic-loaded polymethylmethacrylate (PMMA) bone cement (ALBC) formulation is used in total hip arthroplasties (THAs) and total knee arthroplasties (TKAs), current practice in the United States involves arbitrary choice of the antibiotic loading (herein defined as the ratio of the mass of the antibiotic added to the mass of the cement powder). We suggest there is a need to develop a rational method for determining this loading.


We propose a new method for determining the antibiotic loading to use when preparing a physician-directed ALBC formulation and illustrate this method using three in vitro properties of an ALBC in which the antibiotic was daptomycin.

Materials and Methods

Daptomycin was blended with the powder of the cement using a mechanical mixer. We performed fatigue, elution, and activity tests on three sets of specimens having daptomycin loadings of 2.25, 4.50, and 11.00 wt/wt%. Correlational analyses of the results of these tests were used in conjunction with stated constraints and a nonlinear optimization method to determine the daptomycin loading to use.


With an increase in daptomycin loading, the estimated mean fatigue limit of the cement decreased, the estimated elution rate of the antibiotic increased, and the percentage inhibition of staphylococcal growth by the eluate remained unchanged at 100%. For a daptomycin-loaded PMMA bone cement we computed the optimum amount of daptomycin to mechanically blend with 40 g of cement powder is 1.36 g.


We suggest an approach that may be used to determine the amount of antibiotic to blend with the powder of a PMMA bone cement when preparing a physician-directed ALBC formulation, and highlighted the attractions and limitations of this approach.

Clinical Relevance

When a physician-directed ALBC formulation is selected for use in a TKA or THA, the approach we detail may be employed to determine the antibiotic loading to use rather than the empirical approach that is taken in current clinical practice.


PMMA Fatigue Life Tobramycin Bone Cement Fatigue Limit 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



We thank Cubist Pharmaceuticals and Wright Medical Technology for generous donation of the daptomycin and the bone cement, respectively, used in this investigation and Dr. Teong Tan for help with the optimization work.


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Copyright information

© The Association of Bone and Joint Surgeons® 2010

Authors and Affiliations

  • Gladius Lewis
    • 1
  • Jennifer L. Brooks
    • 2
    Email author
  • Harry S. Courtney
    • 3
  • Yuan Li
    • 1
  • Warren O. Haggard
    • 2
  1. 1.Department of Mechanical EngineeringThe University of MemphisMemphisUSA
  2. 2.Department of Biomedical EngineeringThe University of MemphisMemphisUSA
  3. 3.Veterans Affairs Medical Center and Department of MedicineUniversity of Tennessee Health Science CenterMemphisUSA

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