Practical Applications of Antibiotic-Loaded Bone Cement for Treatment of Infected Joint Replacements

Department of Orthopaedics, Mayo Clinic and Mayo Foundation, Rochester, MN 55906, USA.
Clinical Orthopaedics and Related Research (Impact Factor: 2.77). 11/2004; 427(427):79-85. DOI: 10.1097/01.blo.0000143806.72379.7d
Source: PubMed


The use of antibiotic-loaded bone cement is an accepted treatment method for infected joint arthroplasties. It is helpful to separate the use of antibiotic-loaded bone cement as a method of prophylaxis as compared with the treatment of an established infection. A low dose of antibiotic-loaded bone cement (< or = 1 g of antibiotic per batch of cement) should be used for prophylaxis, and high-dose antibiotic-loaded bone cement (> 1 g antibiotic per batch of cement) is indicated for treatment. The only commercially available antibiotic-loaded bone cement products are low dose, with the use of tobramycin or gentamicin as an antibiotic selection. High-dose antibiotic-loaded bone cement requires hand mixing by the surgeon to facilitate the use of high dosages and choices of multiple antibiotics. Treatment of infected hip and knee arthroplasties with high-dose antibiotic-loaded bone cement is aided by the use of spacers of various shapes and sizes. These spacers, whether they are static or articulating (mobile), are meant to provide local delivery of antibiotics, stabilization of soft tissues, facilitation of an easier reimplantation, and improved clinical outcomes.

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    • "This is followed by 3–6 months of oral therapy of doxycycline, minocycline, or trimethoprim-sulfamethoxazole with some patients requiring replacement surgery [11]. Over the last few years antibiotic impregnated cement spacers have been used to avoid infection and promote early ambulation [12]. Liu et al., [13] loaded strontium-containing hydroxyapatite (Sr-HA) bone cement with gentamicin sulphate to generate an efficient bioactive antibiotic drug delivery system for treatment of bone defects. "
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    ABSTRACT: With this rise in surgical procedures it is important to focus on the mobility and safety of the patient and reduce the infections that are associated with hip replacements. We examine the mechanical properties of gentamicin sulphate as a model antimicrobial layer for titanium-alloy based prosthetic hips to help prevent methicillin-resistant Staphylococcus aureus infection after surgery. A top layer of poly(lactic-co-glycolic acid) is added to maintain the properties of the gentamicin sulphate as well as providing a drug delivery system. Through the use of nanoindentation and micro-scratch techniques it is possible to determine the mechanical and adhesive properties of this system. Nanoindentation determined the modulus values for the poly(lactic-co-glycolic acid) and gentamicin sulphate materials to be 8.9 and 5.2 GPa, respectively. Micro-scratch established that the gentamicin sulphate layer is strongly adhered to the Ti alloy and forces of 30 N show no cohesive or adhesive failure. It was determined that the poly(lactic-co-glycolic acid) is ductile in nature and delaminates from the gentamicin sulphate layer of at 0.5 N.
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    • "Two-stage revision has been shown to yield a high rate of infection eradication and survival of the reimplanted THA and is the standard of care in North America for infected THA [10, 11]. An articulating antibiotic spacer helps deliver local antibiotics, maintains joint mobility, and facilitates reimplantation by reducing soft tissue contracture and scar formation [12]. "
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    ABSTRACT: Two-stage revision has been shown to be the most successful treatment in eradicating deep infection following total hiparthroplasty. We identified 62 patients treated by a two-stage revision. We defined "successful revision" as negative intraoperative cultures and no further infection-related procedure. We defined "eradication of infection" on the basis of negative cultures and clinical diagnosis at least one year after 2(nd) stage procedure. After a mean follow up of 2.7 years, eradication of the infection was documented in 91.1%, and a successful two-stage revision in 85.7% of patients. We observed no association between higher pre-reimplantation levels of ESR and C-reactive protein and lower likelihood of successful two-stage revision. We found an association between a history of another previous infected prosthetic joint and a failed 2(nd) stage procedure. Failure to achieve eradication of infection and successful two-stage revision occurs infrequently. Patients with prior history of a previous prosthetic joint infection are at higher risk of failure.
    The Open Orthopaedics Journal 05/2014; 8(1):118-24. DOI:10.2174/1874325020140515002
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    • "Antibioticimpregnated implants are particularly attractive because they not only deliver high tissue levels of antibiotics but also help obliterate the dead space that occurs after bone debridement (Gitelis and Brebach, 2002). For many years, polymethylmethacrylate (PMMA) beads impregnated with vancomycin, tobramycin or gentamicin have been the main local delivery system in osteomyelitis therapy (Hanssen and Spangehl, 2004). PMMA beads, however, are far from being an ideal antibiotic carrier. "
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    ABSTRACT: In this work, osteoconductive composite materials comprising a large volume fraction of a bioresorbable calcium phosphate ceramic (CaP) and a smaller amount of a polycaprolactone polymer (PCL) were studied as a degradable antibiotic carrier material for treatment of osteomyelitis. Beads loaded with 1 and 4 wt.% vancomycin were prepared by admixing dissolved drug to an in situ synthesized dicalcium phosphate (DCP)-PCL or solution-mixed beta-tricalcium phosphate (βTCP)-PCL composite powder followed by high pressure consolidation of the blend at room temperature. Vancomycin release was measured in phosphate-buffered saline (PBS) at 37°C. All the beads gradually released the drug over the period of 4 to 11 weeks, depending on the composite matrix homogeneity and porosity. Mathematical modeling using the Peppas equation showed that vancomycin elution was diffusion controlled. The stability of the antibiotic after high pressure application at room temperature was demonstrated by high-performance liquid chromatography-mass spectrometry (HPLC-MS) studies and MIC testing. The preservation of the structure and activity of vancomycin during the processing of composite beads and its sustained in vitro release profile suggest that high pressure consolidated CaP-PCL beads may be useful in the treatment of chronic bone infections as resorbable delivery vehicles of vancomycin and even of thermally unstable drug substances.
    European journal of pharmaceutical sciences: official journal of the European Federation for Pharmaceutical Sciences 05/2014; 62. DOI:10.1016/j.ejps.2014.05.008 · 3.35 Impact Factor
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