Vacuum-Mixing Significantly Changes Antibiotic Elution Characteristics of Commercially Available Antibiotic-Impregnated Bone Cements

Meyer, Jill; Piller, Geoff; Spiegel, Carol A.; Hetzel, Scott; Squire, Matthew W.

doi:10.2106/jbjs.j.01777

Cited by 79 publications

(50 citation statements)

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“…[1] However, implantation of a foreign body into an area where bone has been resected due to trauma or pathology could precipitate an infection due to the presence of oral flora and colonization of the material. Some clinical products, such as polymethylmethacrylate (PMMA)-based bone cements, have incorporated antibiotics for local control of infection [2][3][4][5][6]. The release of these antibiotics is rapid, and the majority of the loaded antibiotic remains in the cement, rendering them ineffective at long-term infection control.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of antibiotic releasing porous polymethylmethacrylate space maintainers in an infected composite tissue defect model

et al. 2013

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This study evaluated the in vitro and in vivo performance of antibiotic-releasing porous polymethylmethacrylate (PMMA)-based space maintainers comprising a gelatin hydrogel porogen and a poly(DL-lactic-co-glycolic acid) (PLGA) particulate carrier for antibiotic delivery. Colistin was released in vitro from either gelatin or PLGA microparticle loaded PMMA constructs, with gelatin-loaded constructs releasing colistin over approximately 7 days and PLGA microparticle-loaded constructs releasing colistin up to 8 weeks. Three formulations with either a burst release or extended release in different doses were tested in a rabbit mandibular defect inoculated with Acinetobacter baumannii (2 × 10 7 colony forming units/mL). In addition, one material control that released antibiotic but was not inoculated with A. baumannii was tested. A. baumannii was not detectable in any animal after 12 weeks by culture of the defect, saliva, or blood. Defects with high-dose, extended-release implants had greater soft tissue healing compared to defects with burst release implants, with 8 out of 10 animals showing healed mucosae compared to 2 out of 10 with healed mucosae, respectively. Extended release of locally delivered colistin via a PLGA microparticle carrier improved soft tissue healing over the implants compared to burst release of colistin from a gelatin carrier.

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Section: Introductionmentioning

confidence: 99%

Evaluation of antibiotic releasing porous polymethylmethacrylate space maintainers in an infected composite tissue defect model

et al. 2013

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“…In addition, while drug elution into the peri-prosthetic space is desired for 3–8 weeks, the elution from antibiotic-eluting BC spacers often falls below the minimum inhibitory concentration (MIC) of common PJI bacterial contaminants within 1 week [20]. Low antibiotic concentration without complete eradication of bacteria has the potential of increasing antibiotic resistance [21].…”

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confidence: 99%

A fully functional drug-eluting joint implant

et al. 2017

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Despite advances in orthopedic materials, the development of drug-eluting bone and joint implants that can sustain the delivery of the drug and maintain the necessary mechanical strength in order to withstand loading has remained elusive. Here, we demonstrate that modifying the eccentricity of drug clusters and the percolation threshold in ultrahigh molecular weight polyethylene (UHMWPE) results in maximized drug elution and in the retention of mechanical strength. The optimized UHMWPE eluted antibiotic at a higher concentration for longer than the clinical gold standard antibiotic-eluting bone cement while retaining the mechanical and wear properties of clinically used UHMWPE joint prostheses. Treatment of lapine knees infected with Staphylococcus aureus with the antibiotic-eluting UHMWPE led to complete bacterial eradication and to the absence of detectable systemic effects. We argue that the antibiotic-eluting UHMWPE joint implant is a promising candidate for clinical trials.

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“…[1,2,11,12] Type and form of the antibiotic also change the properties of cement differently. [2,3] As already shown and explained in our study, the main variant in such an experiment is volumetric expansion.…”

Section: Discussionmentioning

confidence: 99%

Simple method for increasing drug elution from polymethylmethacrylate bone cement

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2017

Eklem Hastalik Cerrahisi

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ÖZAmaç: Bu çalışmada sitrik asit ve sodyum bikarbonat karışımının polimetilmetakrilat kemik çimentosunda efervesan olarak kullanımının daha iyi ilaç elüsyonu açısından etkileri araştırıldı. Hastalar ve yöntemler: İçeriğinde 10'ar gram glikoz ve farklı miktarlarda efervesan (E) olan; parça sayıları (P), yüzey alanları, hacimleri ve poroziteleri farklı silindir çimento bloklar hazırlandı. Tüm blokların fiziksel özellikleri hesaplandı. Bloklar serum fizyolojik içeren kavanozlara konuldu ve sıvı içerisine salınan glikoz konsantrasyonları önceden belirlenen aralıklarda ölçüldü. Elüsyon hızı ve fiziksel özellikler arasındaki ilişkiler tanımlandı. Bulgular: Efervesanlı numunelerden elüsyon oranları anlamlı derecede daha yüksekti. Kırk beşinci günün sonunda E 0 P 1 glikoz içeriğinin ortalama %21'ini saldı. Bu değer E 0 P 2 , E 0 P 4 , E 2 P 1 ve E 4 P 1 için sırasıyla %38, %61, %82 ve %88 idi. Su absorbsiyon oranları, yüzey alanları, porozite ve glikoz elüsyonu oranları arasında güçlü korelasyonlar saptandı (r= 0,942, p<0,01; r= 0,894, p<0,05; r= 0,918, p<0,05). Sonuç: Sodyum bikarbonat ve sitrik asidin efervesan olarak kemik çimentosu içinde kullanılması, daha iyi antibiyotik elüsyonu için tatmin edici porozite oluşumunu sağlamaktadır. Yekpare bir spacer ve daha iyi lokal antibiyotik elüsyonu gereken durumlarda bu yöntem işe yarayabilir.Anahtar sözcükler: Antibiyotik, kemik çimentosu; çimento spacer; elüsyon; polimetilmetakrilat. ABSTRACT Objectives:This study aims to investigate the effects of the use of citric acid and sodium bicarbonate mixture as an effervescent in polymethylmethacrylate bone cement in terms of better drug elution. Patients and methods: Multiple cylinder cement blocks each containing 10 g of glucose and different amounts of effervescent (E), with different numbers of pieces (P), surface areas, volumes, and porosities were prepared. Physical properties of all blocks were calculated. Blocks were placed in jars containing saline solutions and the released glucose concentrations were measured at predefined intervals. Correlations between elution rate and physical properties were defined. Results: Elution rates were significantly higher in samples with effervescent. At the end of 45 th day, E 0 P 1 released mean 21% of its glucose content. This value was 38%, 61%, 82% and 88% for E 0 P 2 , E 0 P 4 , E 2 P 1 and E 4 P 1 , respectively. Strong correlations were detected between water absorption ratio, surface areas, porosity and glucose elution rates (r= 0.942, p<0.01; r= 0.894, p<0.05; r= 0.918, p<0.05). Conclusion: Using sodium bicarbonate and citric acid as effervescent in bone cement provides satisfactory porosity development for better antibiotic elution. This method may be useful when a monolithic spacer and better local antibiotic elution are required.

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Vacuum-Mixing Significantly Changes Antibiotic Elution Characteristics of Commercially Available Antibiotic-Impregnated Bone Cements

Abstract: The method by which antibiotic-containing polymethylmethacrylate products are prepared significantly affects their antibiotic elution characteristics. The effect of vacuum-mixing on antibiotic elution is product-specific.

Cited by 79 publications

References 20 publications

Evaluation of antibiotic releasing porous polymethylmethacrylate space maintainers in an infected composite tissue defect model

Evaluation of antibiotic releasing porous polymethylmethacrylate space maintainers in an infected composite tissue defect model

A fully functional drug-eluting joint implant

Simple method for increasing drug elution from polymethylmethacrylate bone cement

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