Abstract
Objectives: The objective is to present the antibiotic elution from a locally implanted gentamicin containing hydroxyapatite and calcium sulphate bone substitute with an extended follow up of 30 days.We also compare the pharmacokinetics of the ceramic bone substitute with a published study on gentamicin containing poly (methyl methacrylate) (PMMA) bone cement used in primary total hip arthroplasty.Methods: Gentamicin release was measured in the urine for a month and the serum for 4 days in 10 patients operated for trochanteric hip fractures and 10 patients in uncemented hip revisions. 17 patients were followed up at one year and 3 patients at 6 months.Results and Discussion: The gentamicin concentrations measured in serum were low and approximately 100 times less than in urine during the first days, indicating high local concentrations at the implant site. The elution from the biphasic bone substitute showed a stronger burst and higher gentamicin concentrations for the first week compared to that reported for PMMA used in hip arthroplasty. Also, for the bone substitute a complete gentamicin elution was obtained after 30 days, while for the PMMA cement sub-inhibitory MIC levels of gentamicin were still present in urine 60 days past surgery. No infections were detected.Conclusions: A new biphasic bone substitute containing antibiotics could potentially be used to prevent infection in patients treated for trochanteric hip fractures or uncemented hip revisions. The gentamicin elution from the bone substitute is efficient with high initial local gentamicin concentrations and complete release at 30 days.
Highlights
Local delivery of antibiotics has been shown to be effective in preventing infections in total hip surgery[1]
The elution of gentamicin from the biphasic ceramic bone substitute had an initial serum peak and it flattened out after the first days to stay at low levels for the rest of the sampling time (Fig 1)
This study presents a prolonged follow-up of gentamicin elution from a biphasic ceramic bone substitute used for augmentation of internal fixations in trochanteric fractures and of uncemented hip revisions
Summary
Local delivery of antibiotics has been shown to be effective in preventing infections in total hip surgery[1]. These patients are often old and more prone to be affected by infections than younger patients groups. This study is an addition to previously short term published data[6] on the gentamicin elution from the biphasic bone substitute CERAMENTTM|G. The objective of this new study is to present the gentamicin elution from the same product in major hip surgery over an extended time period, 1 month vs 1 week, as well as to compare this elution with reported release curves from PMMA7
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