A Comparison of Gentamicin-Impregnated Polymethylmethacrylate Bead Implantation to Conventional Parenteral Antibiotic Therapy in Infected Total Hip and Knee Arthroplasty

Cl, Nelson; Rp, Evans; Jd, Blaha; Calhoun, Jason H.; Henry, Stephen L.; Mj, Patzakis

doi:10.1097/00003086-199310000-00014

Cited by 111 publications

(66 citation statements)

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“…These more functional spacers are fundamentally different from static spacers that have been evaluated previously [8,13,21,23]. They are relatively thin, and it is intuitively obvious they have a much greater surface area to volume ratio.…”

Section: Discussionmentioning

confidence: 96%

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An articulated antibiotic spacer used for infected total knee arthroplasty: A comparative in vitro elution study of Simplex® and Palacos® bone cements

Stevens

Tetsworth

Calhoun

et al. 2005

Journal Orthopaedic Research

137

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For the staged management of infected total knee arthroplasty (TKA), antibiotic laden polymethylmethacrylate (PMMA) spacers have been recommended. Antibiotic-impregnated PMMA spacers target drug delivery, achieving high local levels while limiting the potential for host toxicity associated with parenteral antimicrobial therapy. This study examined the elution characteristics of an articulating PMMA TKA spacer that has been useful clinically. Tobramycin and vancomycin are both active against many organisms leading to joint infections. We used various combined antibiotic concentrations (maintaining a relative ratio of 55% tobramycin to 45% vancomycin w/w), and then assayed the elution profile of the TKA spacer in vitro. Additionally, the elution qualities of two brands of bone cement, Simplexm and Palaces@, were compared. Briefly, three groups of PMMA spacers, impregnated with different antibiotic loads, were fashioned from a mold replicating a femoral TKA component. The entire spacer surface area was immersed in sterile phosphate buffered saline (PBS) in a 1.6 ratio of grams of cement to milliliters of PBS and incubated at 37 "C for 24 h. After 24 h, aliquot eluates were taken, the PBS discarded, and replaced with fresh, sterile PBS. PBS was changed daily and an aliquot was taken at least weekly for nine weeks. Eluate samples were stored at -70 "C until assayed. Each spacer eluate sample's antibiotic concentration was determined by disc diffusion bioassay against Bacillus subtilis. Mean zone inhibition diameters were extrapolated from the standard curve to yield micrograms per milliliter of antibiotic in PBS. In all groups the Palaces@ spacers demonstrated higher elution levels, above the MIC for the organism used, for a longer period of time than those made with Simplexa. Based on the observed elution profiles, antibiotic-impregnated Palaces@ bone cement may offer a more effective vehicle for local drug delivery during staged treatment of infected TKA.

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Section: Discussionmentioning

confidence: 96%

“…Articulating spacers are, however, fundamentally different from other PMMA spacers that have been studied previously [8,13,21,23]. It is therefore paramount to clearly define their potential efficacy as a local antibiotic delivery vehicle.…”

Section: M Stevens Et Al I Journul Of Orthopaedicmentioning

confidence: 99%

An articulated antibiotic spacer used for infected total knee arthroplasty: A comparative in vitro elution study of Simplex® and Palacos® bone cements

Stevens

Tetsworth

Calhoun

et al. 2005

Journal Orthopaedic Research

137

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show abstract

“…In a randomized study (4), high local antibiotic bioavailability from implantable beads in infected joint arthroplasties was found to be as effective as conventional parenteral antibiotic treatment. The nonadherent state of CS pellets versus bone substitutes, like polymethylmethacrylate, could be advantageous for antibiotic delivery in chronic osteomyelitis with antibiotic resistance (5).…”

Section: Use Of Tobramycinimpregnated Calcium Sulphate Pellets In Addmentioning

confidence: 99%

“…In contrast, AT1R blockade increased insulin secretion by 40 -60% in Zucker diabetic fatty (ZDF) rats (4) and in obese db/db mice (5), thereby delaying the otherwise premature onset of diabetes in the latter animal model. If this were the case in humans, it would provide an explanation for the finding that AT1R antagonist treatment reduces the incidence of type 2 diabetes by ϳ25% in high-risk individuals in clinical trials despite no improvement in insulin sensitivity in most human studies using the euglycemic clamp technique (6).…”

mentioning

confidence: 99%

Use of Tobramycin-Impregnated Calcium Sulphate Pellets in Addition to Oral Antibiotics

et al. 2007

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“…6 The authors concluded that elution rate is independent of the fabrication mode as long as the bead is similar in size and is composed of the same material. 12 To add an antibiotic to the PMMA, the antibiotic is mixed with the powder cement polymer before addition of the liquid methylmethacrylate. The antibiotic used should be a broad-spectrum antibiotic if empirical treatment is instituted, active against the etiologic pathogen and must be available as a powder.…”

mentioning

confidence: 99%

Evaluation of in vitro serial antibiotic elution from meropenem-impregnated polymethylmethacrylate beads after ethylene oxide gas and autoclave sterilization

Baez

Langston²,

Givaruangsawat³

et al. 2011

Vet Comp Orthop Traumatol

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Summary Objectives: To determine the elution properties of meropenem and to compare the elutions of meropenem-impregnated polymethylmethacrylate (PMMA) beads without sterilization (P-M-C) to those sterilized with steam (P-M-A) and ethylene oxide gas (P-M-EO). Methods: A commercial bead mould was used to produce four groups of beads: one group without antibiotic (negative control), and three groups of meropenem-impregnated beads: P-M-C, P-M-A, and P-M-EO. The beads were placed in a phosphate buffered solution and eluent samples were collected. Concentrations of the antibiotic in eluent samples from the two sterilized groups and the control beads were determined using a microbiological assay at 1, 3, 6 and 12 hours and at 1, 2, 3, 6, 9, 12, 15, 18, 22, 26, and 30 days. Results: The microbiological assay resulted in no zone of inhibition at all time periods for the P-M-A samples and the samples of PMMA without antimicrobial. The meropenem concentration on the eluent remained above 4 mcg/ml for 15 days in the P-M-C group and until day 18 for P-M-EO group. There was no statistical difference in AUC0-∞ (p <0.318), however significance did occur for MRT (p <0.005) when comparing P-M-C and P-M-EO with the later being higher. Discussion: The meropenem incorporated in the PMMA beads eluted effectively and gradually decreased after the 24 hour peak, but remained above the concentration level of 4 mcg/ml for 15 days in the P-M-C group and until day 18 for P-M-EO group. Ethylene oxide does not adversely affect meropenem’s elution from PMMA beads.

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A Comparison of Gentamicin-Impregnated Polymethylmethacrylate Bead Implantation to Conventional Parenteral Antibiotic Therapy in Infected Total Hip and Knee Arthroplasty

Cited by 111 publications

References 0 publications

An articulated antibiotic spacer used for infected total knee arthroplasty: A comparative in vitro elution study of Simplex® and Palacos® bone cements

An articulated antibiotic spacer used for infected total knee arthroplasty: A comparative in vitro elution study of Simplex® and Palacos® bone cements

Use of Tobramycin-Impregnated Calcium Sulphate Pellets in Addition to Oral Antibiotics

Evaluation of in vitro serial antibiotic elution from meropenem-impregnated polymethylmethacrylate beads after ethylene oxide gas and autoclave sterilization

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