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

ArticleinClinical Orthopaedics and Related Research 427(427):79-85 · November 2004with21 Reads
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.
    • "Previous in vitro studies reported that VCM causes less osteoclast activity compared to tobramycin, cefazolin, and gentamicin. Moreover, cell-line comparisons showed that VCM in 125 g/mL doses is toxic to osteoblast-and chondroblast-like cells [1,6,26,27]. "
    [Show abstract] [Hide abstract] ABSTRACT: Many studies have shown that the toxic effects of local antibiotics on bone and cartilage limit orthopedic surgeons. In this study, we evaluated three antibacterial agents used locally to treat highly mortal and morbid diseases in the field of orthopedics, such as septic arthritis. Are vancomycin, teicoplanin, and linezolid, which are archenemies of Staphylococcus aureus, really toxic to chondrocytes? The purpose of the study was to investigate the effects of antibiotics, which are used against S. aureus, on human chondrocytes in vitro. Primary cell cultures obtained from gonarthrosis patients were divided into two main groups. One of these groups was designated as the control chondrocyte culture. The other group was divided into three subgroups, and each group was exposed to vancomycin, teicoplanin, or linezolid. Cell culture samples were characterized by immunophenotyping following incubation with the three different antibiotics. Before and after the agents were administered, the cultures were subjected to inverted and environmental scanning electron microscopy. The number of live cells and the proliferation rate were monitored with the MTT-assay. We found that vancomycin, teicoplanin, and linezolid do not have chondrotoxic effects. Vancomycin, teicoplanin, and linezolid had no chondrotoxic activity during in vitro culture, which supports the argument that these agents can safely be used in orthopedic surgery, especially against methicillin-resistant S. aureus agents.
    Full-text · Article · Nov 2015
    • "days , effective serum levels describe sensitivity of bacteria to the antibiotics. Most bacteria defined as resistant by these criteria might be sensitive when exposed to local antibiotics [7, 55, 64]. To guide the antimicrobial treatment properly, pathogens should be reconsidered to be either sensitive or resistant to the antibiotic levels achievable locally [7, 31, 55]. "
    [Show abstract] [Hide abstract] ABSTRACT: Since the first description in 2002 by Paley and Herzenberg, antibiotic bone cement nails (ACNs) have become an effective tool in the orthopaedic trauma surgeons' hands. They simultaneously elute high amounts of antibiotics into medullary canal dead space and provide limited stability to the debrided long bone. In this paper, we perform a systematic review of current evidence on ACNs in orthopaedic trauma and provide an up-to-date review of the indications, operative technique, failure mechanisms, complications, outcomes, and outlooks for the ACNs use in long bone infection.
    Full-text · Article · Oct 2015
    • "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. "
    [Show abstract] [Hide abstract] 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.
    Full-text · Article · Oct 2015
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