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Kuris EO, Osorio C, Anderson GM, Younghein JA, McDonald CL, Daniels AH. Utilization of Antibiotic Bone Cement in Spine Surgery: Pearls, Techniques, and Case Review. Orthop Rev (Pavia) 2023; 15:90618. [PMID: 38116585 PMCID: PMC10727979 DOI: 10.52965/001c.90618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 09/11/2023] [Indexed: 12/21/2023] Open
Abstract
Vertebral osteomyelitis (VO) encompasses a spectrum of spinal infections ranging from isolated mild vertebral osteomyelitis to severe diffuse infection with associated epidural abscess and fracture. Although patients can often be treated with an initial course of intravenous antibiotics, surgery is sometimes required in patients with sepsis, spinal instability, neurological compromise, or failed medical treatment. Antibiotic bone cement (ABC) has been widely used in orthopedic extremity surgery for more than 150 years, both for prophylaxis and treatment of bacterial infection. However, relatively little literature exists regarding its utilization in spine surgery. This article describes ABC utilization in orthopedic surgery and explains the technique of ABC utilization in spine surgery. Surgeons can choose from multiple premixed ABCs with variable viscosities, setting times, and antibiotics or can mix in antibiotics to bone cements themselves. ABC can be used to fill large defects in the vertebral body or disc space or in some cases to coat instrumentation. Surgeons should be wary of complications such as ABC extravasation as well as an increased difficulty with revision. With a thorough understanding of the properties of the cement and the methods of delivery, ABC is a powerful adjunct in the treatment of spinal infections.
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Affiliation(s)
- Eren O Kuris
- Orthopedic Surgery Warren Alpert School of Medicine at Brown University
| | - Camilo Osorio
- Orthopedic Surgery Warren Alpert School of Medicine at Brown University
| | | | | | | | - Alan H Daniels
- Orthopedic Surgery Warren Alpert School of Medicine at Brown University
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Janssen DMC, Willems P, Geurts J, Arts CJJ. Antibiotic release from PMMA spacers and PMMA beads measured with ELISA: Assessment of in vitro samples and drain fluid samples of patients. J Orthop Res 2023; 41:1831-1839. [PMID: 36597743 DOI: 10.1002/jor.25510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 11/30/2022] [Accepted: 12/21/2022] [Indexed: 01/05/2023]
Abstract
For prosthetic joint infections, antibiotic loaded poly methyl methacrylate (PMMA) spacer or beads can be used to release high concentrations of antibiotics locally at the infection site, while minimizing systemic toxicity. The aim of this study is to determine in vitro and in vivo pharmacokinetic release profile of antibiotics from PMMA spacers and PMMA beads. For the in vitro experiment, the PMMA spacers or beads were submerged in phosphate-buffered saline and gentamicin concentrations were determined from collected specimen at several times points, measured with enzyme-linked immunosorbent assays (ELISA). To assess the in vivo antibiotic release profile of different spacers, wound drainage fluid samples were collected after implantation of a spacer over a period of maximum 14 days. After 48 h, the burst gentamicin concentration elution was 9862 ± 1782 ng/ml (mean ± SD) from spacers versus 38,394 ± 7071 ng/ml (mean ± SD) for beads. Over 35 days, spacers had eluted a cumulative mean concentration of 13,812 ± 3548 versus 55,048 ± 12,006 ng/ml for beads (p < 0.001). Clinical samples of patients with a Vancogenx® spacer showed higher gentamicin release than Refobacin™ spacers (p < 0.001). This is the first study that measured the release data of local antibiotics with ELISA. Compare to spacers, the exact release values of gentamicin from PMMA beads are more than 10 times higher and reached a maximum much later than spacers. This makes the use of PMMA beads more preferable to use for treatment of the infection itself.
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Affiliation(s)
- Daniël M C Janssen
- Department of Orthopaedic Surgery, Laboratory for Experimental Orthopaedics, Research School CAPHRI, Maastricht University Medical Centre+, Maastricht, The Netherlands
- Sint-Trudo Hospital, Sint-Truiden, Belgium
| | - Paul Willems
- Department of Orthopaedic Surgery, Laboratory for Experimental Orthopaedics, Research School CAPHRI, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Jan Geurts
- Department of Orthopaedic Surgery, Laboratory for Experimental Orthopaedics, Research School CAPHRI, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Chris J J Arts
- Department of Orthopaedic Surgery, Laboratory for Experimental Orthopaedics, Research School CAPHRI, Maastricht University Medical Centre+, Maastricht, The Netherlands
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Chen IC, Su CY, Nien WH, Huang TT, Huang CH, Lu YC, Chen YJ, Huang GC, Fang HW. Influence of Antibiotic-Loaded Acrylic Bone Cement Composition on Drug Release Behavior and Mechanism. Polymers (Basel) 2021; 13:2240. [PMID: 34300997 PMCID: PMC8309450 DOI: 10.3390/polym13142240] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 06/30/2021] [Accepted: 07/05/2021] [Indexed: 11/16/2022] Open
Abstract
Periprosthetic joint infection (PJI) is a devastating complication after total joint replacement with considerable morbidity and large economic burdens. Antibiotic-Loaded Bone Cement (ALBC) has been developed as a valuable tool for local administration and is becoming one of the most effective methods for the prevention and treatment of orthopedic infections. Controlling antibiotic release from ALBC is critical to achieve effective infection control, however, the antibiotic elution rates are generally low, and the mechanisms are poorly understood. Thus, the present study aims to investigate the effects of the basic acrylic bone cement components, including liquid/powder (monomer-to-polymer) ratios, radiopacifier, initiator, and doses of antibiotics on the porosity, antibiotic elution rates and mechanical properties of polymethylmethacrylate (PMMA) based ALBC. The obtained results from the in vitro studies suggested that a reduction in the liquid/powder ratio and an increase in the radiopacifier ratio and gentamicin doses led to increased porosity and release of antibiotic, while the initiator ratio exerted no effect on elution rates. In conclusion, we hope that by varying the composition of ALBC, we could considerably enhance the antibiotic elution rates by increasing porosity, while maintaining an adequate mechanical strength of the bone cements. This finding might provide insights into controlling antibiotic release from ALBC to achieve effective infection control after total joint replacement surgery.
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Affiliation(s)
- I-Cheng Chen
- Accelerator for Happiness and Health Industry, National Taipei University of Technology, No. 1, Sec. 3, Zhongxiao E. Rd., Taipei 10608, Taiwan;
- Department of Chemical Engineering and Biotechnology, National Taipei University of Technology, No. 1, Sec. 3, Zhongxiao E. Rd., Taipei 10608, Taiwan; (C.-Y.S.); (W.-H.N.); (T.-T.H.)
| | - Chen-Ying Su
- Department of Chemical Engineering and Biotechnology, National Taipei University of Technology, No. 1, Sec. 3, Zhongxiao E. Rd., Taipei 10608, Taiwan; (C.-Y.S.); (W.-H.N.); (T.-T.H.)
| | - Wei-Han Nien
- Department of Chemical Engineering and Biotechnology, National Taipei University of Technology, No. 1, Sec. 3, Zhongxiao E. Rd., Taipei 10608, Taiwan; (C.-Y.S.); (W.-H.N.); (T.-T.H.)
| | - Tzu-Tien Huang
- Department of Chemical Engineering and Biotechnology, National Taipei University of Technology, No. 1, Sec. 3, Zhongxiao E. Rd., Taipei 10608, Taiwan; (C.-Y.S.); (W.-H.N.); (T.-T.H.)
| | - Chang-Hung Huang
- Department of Medical Research, Biomechanics Research Laboratory, Mackay Memorial Hospital, New Taipei City 251020, Taiwan; (C.-H.H.); (Y.-C.L.)
- Institute of Biomedical Engineering, National Yang-Ming University, Taipei 11221, Taiwan
| | - Yung-Chang Lu
- Department of Medical Research, Biomechanics Research Laboratory, Mackay Memorial Hospital, New Taipei City 251020, Taiwan; (C.-H.H.); (Y.-C.L.)
- Department of Orthopaedic Surgery, Mackay Memorial Hospital, Taipei 10491, Taiwan
| | - Yu-Jen Chen
- Department of Radiation Oncology, MacKay Memorial Hospital, Taipei 10491, Taiwan;
| | - Gwo-Che Huang
- Department of Radiation Oncology, MacKay Memorial Hospital, Taipei 10491, Taiwan;
| | - Hsu-Wei Fang
- Accelerator for Happiness and Health Industry, National Taipei University of Technology, No. 1, Sec. 3, Zhongxiao E. Rd., Taipei 10608, Taiwan;
- Department of Chemical Engineering and Biotechnology, National Taipei University of Technology, No. 1, Sec. 3, Zhongxiao E. Rd., Taipei 10608, Taiwan; (C.-Y.S.); (W.-H.N.); (T.-T.H.)
- Institute of Biomedical Engineering and Nanomedicine, National Health Research Institutes, No. 35, Keyan Road, Zhunan Town, Miaoli County 35053, Taiwan
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