دورية أكاديمية
Mechanical strength of antibiotic-loaded PMMA spacers in two-stage revision surgery.
| العنوان: | Mechanical strength of antibiotic-loaded PMMA spacers in two-stage revision surgery. |
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| المؤلفون: | Lunz A; Clinic for Orthopedics, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany. andre.lunz@med.uni-heidelberg.de., Knappe K; Clinic for Orthopedics, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany., Omlor GW; Clinic for Orthopedics, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany., Schonhoff M; Laboratory of Biomechanics and Implant Research, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany., Renkawitz T; Clinic for Orthopedics, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany., Jaeger S; Laboratory of Biomechanics and Implant Research, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany. |
| المصدر: | BMC musculoskeletal disorders [BMC Musculoskelet Disord] 2022 Oct 29; Vol. 23 (1), pp. 945. Date of Electronic Publication: 2022 Oct 29. |
| نوع المنشور: | Journal Article |
| اللغة: | English |
| بيانات الدورية: | Publisher: BioMed Central Country of Publication: England NLM ID: 100968565 Publication Model: Electronic Cited Medium: Internet ISSN: 1471-2474 (Electronic) Linking ISSN: 14712474 NLM ISO Abbreviation: BMC Musculoskelet Disord Subsets: MEDLINE |
| أسماء مطبوعة: | Original Publication: London : BioMed Central, [2000- |
| مواضيع طبية MeSH: | Arthritis, Infectious*/surgery , Prosthesis-Related Infections*/drug therapy , Prosthesis-Related Infections*/surgery, Humans ; Polymethyl Methacrylate ; Vancomycin ; Anti-Bacterial Agents/therapeutic use ; Bone Cements/adverse effects ; Reoperation ; Powders ; Sulindac ; Gentamicins |
| مستخلص: | Background: Antibiotic-loaded polymethylmethacrylate (PMMA) bone cement spacers provide high local antibiotic concentrations and patient mobility during the interim period of two-stage revision for periprosthetic joint infection (PJI). This study compares mechanical characteristics of six dual antibiotic-loaded bone cement (dALBC) preparations made from three different PMMA bone cements. The study`s main objective was to determine the effect of time and antibiotic concentration on mechanical strength of dALBCs frequently used for spacer fabrication in the setting of two-stage revision for PJI. Methods: A total of 84 dual antibiotic-loaded bone cement specimens made of either Copal spacem, Copal G + V or Palacos R + G were fabricated. Each specimen contained 0.5 g of gentamicin and either 2 g (low concentration) or 4 g (high concentration) of vancomycin powder per 40 g bone cement. The bending strength was determined at two different timepoints, 24 h and six weeks after spacer fabrication, using the four-point bending test. Results: Preparations made from Copal G + V showed the highest bending strength after incubation for 24 h with a mean of 57.6 ± 1.2 MPa (low concentration) and 50.4 ± 4.4 MPa (high concentration). After incubation for six weeks the bending strength had decreased in all six preparations and Palacos R + G showed the highest bending strength in the high concentration group (39.4 ± 1.6 MPa). All low concentration preparations showed superior mechanical strength compared to their high concentration (4 g of vancomycin) counterpart. This difference was statistically significant for Copal spacem and Copal G + V (both p < 0.001), but not for Palacos R + G (p = 0.09). Conclusions: This study suggests that mechanical strength of antibiotic-loaded PMMA bone cement critically decreases even over the short time period of six weeks, which is the recommended interim period in the setting of two-stage revision. This potentially results in an increased risk for PMMA spacer fracture at the end of the interim period and especially in patients with prolonged interim periods. Finally, we conclude that intraoperative addition of 4 g of vancomycin powder per 40 g of gentamicin-premixed Palacos R + G (Group D) is mechanically the preparation of choice if a dual antibiotic-loaded bone cement spacer with high antibiotic concentrations and good stability is warranted. In any case the written and signed informed consent including the off-label use of custom-made antibiotic-loaded PMMA bone cement spacers must be obtained before surgery. (© 2022. The Author(s).) |
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| فهرسة مساهمة: | Keywords: PMMA bone cement; Periprosthetic joint infection; Spacer; Two-stage revision; dALBC |
| المشرفين على المادة: | 0 (Palacos R+G) 9011-14-7 (Polymethyl Methacrylate) 6Q205EH1VU (Vancomycin) 0 (Anti-Bacterial Agents) 0 (Bone Cements) 0 (Powders) 184SNS8VUH (Sulindac) 0 (Gentamicins) |
| تواريخ الأحداث: | Date Created: 20221030 Date Completed: 20221101 Latest Revision: 20221102 |
| رمز التحديث: | 20231215 |
| مُعرف محوري في PubMed: | PMC9617327 |
| DOI: | 10.1186/s12891-022-05895-5 |
| PMID: | 36309657 |
| قاعدة البيانات: | MEDLINE |
Find this article in full text from Springer Verlag. 
Full Text Finder | تدمد: | 1471-2474 |
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| DOI: | 10.1186/s12891-022-05895-5 |