PMMA Bone Cement: Antibiotic Elution and Mechanical Properties in the Context of Clinical Use

Abstract

This literature review discusses the use of antibiotic loaded polymethylmethacrylate bone cements in arthroplasty. The clinically relevant differences that have to be considered when antibiotic loaded bone cements (ALBC) are used either for long-term implant fixation or as spacers for the treatment of periprosthetic joint infections are outlined. In this context, in vitro findings for antibiotic elution and material properties are summarized and transferred to clinical use.

Multifunctional magnesium-organic framework doped biodegradable bone cement for antibacterial growth, inflammatory regulation and osteogenic differentiation

“…68,69 A conventional strategy of adding functional materials to bone cement, e.g., antibiotics, antibacterial silver, and natural organic matter, could prevent adverse reactions, but often destroyed the overall structure and reduced the mechanical properties of the cement. 22,[70][71][72][73] In addition to having outstanding antibacterial activities against bacterial pathogens within 24 h, the Mg-MOF bone cement could regulate inflammatory immunity by controlling macrophage polarization early on in its use to prevent excessive inflammation. In addition, the incorporation of Mg-MOF could increase the mechanical strength of the bone cement.…”

Mechanically stable rifampin antibiotic cement inhibits Pseudomonas aeruginosa biofilm surface growth

“…31 The mechanical strength and elution characteristics of antibiotics from bone cement are impacted by a number of factors including cement composition, cement porosity, antibiotic selection; combination and concentration; and contaminants such as blood and proteic material. 24,28,32,33 The lack of bacterial growth inhibition from elution samples is very interesting, while clearly inhibiting the direct biofilm growth on the surface. This may suggest the binding of rifampin to PMMA, which can potentially increase the duration of antimicrobial surface protection, while having limited effect away from the surface.…”

“…The elution of rifampin from PMMA also needs to be quantified and described further, with the possible need for mass spectrometry data. Antibiotics such as gentamicin, tobramycin, and vancomycin are frequently used in antibiotic bone cement applications, 24,32 and combination drugs should be considered in the cement construct. Mechanical, elution, and bactericidal studies of a combination of rifampin and these other antibiotics would give clinically relevant information on the best microbial coverage for PJI.…”

Effect of Bone Cement Thickness on the Risk of Scalded Skin in Joint Surgery

“…There is no chemical connection between the bone and the prosthesis, but good fixation of the bone and prosthesis is achieved through microinterlocking and bulk-filling mechanisms. [2][3][4] The solidification process of bone cement goes through four stages-mixing, waiting, application, and setting-to form hardened bone cement so that the prosthesis can be stably fixed. 5 The bone cement polymerization process is an exothermic reaction that releases a large amount of heat.…”

“…Bone cement is self‐setting but has no adhesive properties. There is no chemical connection between the bone and the prosthesis, but good fixation of the bone and prosthesis is achieved through microinterlocking and bulk‐filling mechanisms 2–4 . The solidification process of bone cement goes through four stages—mixing, waiting, application, and setting—to form hardened bone cement so that the prosthesis can be stably fixed 5 …”