Skip to main content
SpringerLink
Log in

Liquid dextran does not increase the elution rate of different antibiotics from bone cement

  • Original Article
  • Published:
European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Purpose

To investigate the possibility of increasing elution of fosfomycin, gentamicin, clindamycin, and vancomycin by the addition of dextran fluid during the cement-mixing phase.

Methods

In 12 test series, we produced standardized, antibiotic-loaded test specimens of cement, with and without addition of dextran, and determined their effectiveness against three reference pathogens in agar diffusion and elution tests.

Results

In the test series using combined agents, Refobacin®-Palacos®R plus fosfomycin continuously produced the largest zone of inhibition, both against methicillin-sensitive Staphylococcus aureus (p = 0.009) and against methicillin-resistant Staphylococcus aureus (p = 0.009). The addition of dextran to the various test series had no useful effect on the size of the zone of inhibition for any of the antibiotics tested.

Conclusions

Dextran supplementation in Refobacin®-Palacos®R bone cement did not have the hope for positive effect on the elution rate of bound antibiotics.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Lieberman JR, Callaway GH, Salvati EA, Pellicci PM, Brause BD (1994) Treatment of the infected total hip arthroplasty with a two-stage reimplantation protocol. Clin Orthop Relat Res 301:205–212 [Epub 1994/04/01]

    PubMed  Google Scholar 

  2. Springer BD, Lee GC, Osmon D, Haidukewych GJ, Hanssen AD, Jacofsky DJ (2004) Systemic safety of high-dose antibiotic-loaded cement spacers after resection of an infected total knee arthroplasty. Clin Orthop Relat Res 427:47–51 [Epub 2004/11/24]

    Article  PubMed  Google Scholar 

  3. Fink B, Vogt S, Reinsch M, Buchner H (2011) Sufficient release of antibiotic by a spacer 6 weeks after implantation in two-stage revision of infected hip prostheses. Clin Orthop Relat Res 469(11):3141–3147 [Epub 2011/06/17]

    Article  PubMed Central  PubMed  Google Scholar 

  4. Nelson CL, Griffin FM, Harrison BH, Cooper RE (1992) In vitro elution characteristics of commercially and noncommercially prepared antibiotic PMMA beads. Clin Orthop Relat Res 284:303–309 [Epub 1992/11/01]

    PubMed  Google Scholar 

  5. McLaren RL, McLaren AC, Vernon BL (2008) Generic tobramycin elutes from bone cement faster than proprietary tobramycin. Clin Orthop Relat Res 466(6):1372–1376 [Epub 2008/03/15]

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  6. van de Belt H, Neut D, Schenk W, van Horn JR, van der Mei HC, Busscher HJ (2000) Gentamicin release from polymethylmethacrylate bone cements and Staphylococcus aureus biofilm formation. Acta Orthop Scand 71(6):625–629 [Epub 2001/01/06]

    Article  PubMed  Google Scholar 

  7. Higuchi T (1961) Rate of release of medicaments from ointment bases containing drugs in suspension. J Pharm Sci 50:874–875 [Epub 1961/10/01]

    Article  CAS  PubMed  Google Scholar 

  8. Kuechle DK, Landon GC, Musher DM, Noble PC (1991) Elution of vancomycin, daptomycin, and amikacin from acrylic bone cement. Clin Orthop Relat Res 264:302–308 [Epub 1991/03/01]

    PubMed  Google Scholar 

  9. Institute CaLS (2012) Performance standards for antimicrobial disk susceptibility tests; Approved Standard. 950 West Valley Road, Suite 2500, Wayne, PA 19087, USA, M02-A11 Vol. 32 No. 1 Replaces M02-A10, Vol. 29 No. 1(Eleventh Edition):1–15

  10. Shiramizu K, Lovric V, Leung A, Walsh WR (2008) How do porosity-inducing techniques affect antibiotic elution from bone cement? An in vitro comparison between hydrogen peroxide and a mechanical mixer. J Orthop Traumatol Off J Italian Soc Orthop Traumatol 9(1):17–22 [Epub 2009/04/23]

    Article  CAS  Google Scholar 

  11. McLaren AC, McLaren SG, McLemore R, Vernon BL (2007) Particle size of fillers affects permeability of polymethylmethacrylate. Clin Orthop Relat Res 461:64–67 [Epub 2007/09/01]

    Article  CAS  PubMed  Google Scholar 

  12. Downes S (1991) Methods for improving drug release from poly(methyl)methacrylate bone cement. Clin Mater 7(3):227–231 [Epub 1990/12/10]

    Article  CAS  PubMed  Google Scholar 

  13. Virto MR, Frutos P, Torrado S, Frutos G (2003) Gentamicin release from modified acrylic bone cements with lactose and hydroxypropylmethylcellulose. Biomaterials, 24(1):7–87 [Epub 2002/11/06]. doi:10.1016/S0142-9612(02)00254-5

  14. Seldes RM, Winiarsky R, Jordan LC, Baldini T, Brause B, Zodda F et al (2005) Liquid gentamicin in bone cement: a laboratory study of a potentially more cost-effective cement spacer. J Bone Joint Surg Am 87(2):268–272 [Epub 2005/02/03]

    Article  PubMed  Google Scholar 

  15. Ensing GT, van Horn JR, van der Mei HC, Busscher HJ, Neut D (2008) Copal bone cement is more effective in preventing biofilm formation than Palacos R-G. Clin Orthop Relat Res 466(6):1492–1498 [Epub 2008/03/14]

    Article  PubMed Central  PubMed  Google Scholar 

  16. Buranapanitkit B, Srinilta V, Ingviga N, Oungbho K, Geater A, Ovatlarnporn C (2004) The efficacy of a hydroxyapatite composite as a biodegradable antibiotic delivery system. Clin Orthop Relat Res 424:244–252 [Epub 2004/07/09]

    Article  PubMed  Google Scholar 

  17. Cui Q, Mihalko WM, Shields JS, Ries M, Saleh KJ (2007) Antibiotic-impregnated cement spacers for the treatment of infection associated with total hip or knee arthroplasty. J Bone Joint Surg Am 89(4):871–882 [Epub 2007/04/04]

    Article  PubMed  Google Scholar 

  18. Anagnostakos K, Kelm J, Regitz T, Schmitt E, Jung W (2005) In vitro evaluation of antibiotic release from and bacteria growth inhibition by antibiotic-loaded acrylic bone cement spacers. J Biomed Mater Res B Appl Biomater 72(2):373–378 [Epub 2004/12/04]

    Article  PubMed  Google Scholar 

  19. Seligson D, Popham GJ, Voos K, Henry SL, Faghri M (1993) Antibiotic-leaching from polymethylmethacrylate beads. J Bone Joint Surg Am 75(5):714–720 [Epub 1993/05/01]

    CAS  PubMed  Google Scholar 

  20. Neut D, Kluin OS, Thompson J, van der Mei HC, Busscher HJ (2010) Gentamicin release from commercially-available gentamicin-loaded PMMA bone cements in a prosthesis-related interfacial gap model and their antibacterial efficacy. BMC Musculoskelet Disord 11:258 [Epub 2010/11/12]

    Google Scholar 

  21. Shinsako K, Okui Y, Matsuda Y, Kunimasa J, Otsuka M (2008) Effects of bead size and polymerization in PMMA bone cement on vancomycin release. Bio-Med Mater Eng 18(6):377–385 [Epub 2009/02/07]

    CAS  Google Scholar 

  22. Dunne N, Buchanan F, Hill J, Newe C, Tunney M, Brady A et al (2008) In vitro testing of chitosan in gentamicin-loaded bone cement: no antimicrobial effect and reduced mechanical performance. Acta Orthop 79(6):851–860 [Epub 2008/12/17]

    Article  PubMed  Google Scholar 

  23. McLaren AC, Nelson CL, McLaren SG, De CGR (2004) The effect of glycine filler on the elution rate of gentamicin from acrylic bone cement: a pilot study. Clin Orthop Relat Res 427:25–27 [Epub 2004/11/24]

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We thank Dr. Rainer Specht (Biomet Merck Biomaterials GmbH, Darmstadt, Germany) for technical support, for providing materials, and for allowing us to use their laboratory facilities. This paper contains data from an as yet unpublished thesis by the author BK. The experiments comply with the current laws of Germany.

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Johannes Gutenberg University, Langenbeckstraße 1, 55131, Mainz, Germany

    K. E. Roth, B. Krause, G. Maier, C. Schoellner & P. M. Rommens

  2. Department of Microbiology, Johannes Gutenberg University, Mainz, Germany

    E. Siegel

Authors
  1. K. E. Roth
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. B. Krause
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. E. Siegel
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. G. Maier
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. C. Schoellner
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. P. M. Rommens
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to K. E. Roth.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Roth, K.E., Krause, B., Siegel, E. et al. Liquid dextran does not increase the elution rate of different antibiotics from bone cement. Eur J Orthop Surg Traumatol 25, 83–89 (2015). https://doi.org/10.1007/s00590-013-1408-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00590-013-1408-6

Keywords

Search

Navigation