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.
Highlights
To evaluate whether the anti-bacterial effects of PMMA bone cements loaded with antibiotics were eliminated by heat produced during polymerization, bacterial inhibition by released antibiotics was examined in vitro
The results indicated that altering the monomer-to-powder ratio of Antibiotic-Loaded Bone Cement (ALBC) considerably affected the material behavior of the cement, where the lower ratio could considerably enhance the release of gentamicin without adding extra additives, such as xylitol, onto the PMMA cement
It has been indicated that sustained antibiotic release over a period of time may depend on the penetration depth as determined by the bulk porosity of the cement and antibiotics, which may diffuse through the interconnected series of cracks and voids in the polymer matrix [15,19]
Summary
Demand for arthroplasties has increased in recent years and is estimated to grow drastically by 174% and 673% for primary total hip arthroplasties (THA) and primary total knee arthroplasties (TKA), respectively, by 2030 [1]. Despite great survival rates and improved outcomes of arthroplasties, various failures and complications were reported, including periprosthetic joint infection (PJI), which is one of the most common failure mechanisms. PJI occurs following primary THA and TKA, with rates ranging between. 0.3% and 1.9%, and up to 10% in revision cases [2,3]. PJI is a devastating failure with considerable morbidity and large economic burdens, both for affected patients and the healthcare system. Antibiotic-loaded bone cement (ALBC) has been developed as a valuable tool and is becoming one of the most effective methods for the prevention and treatment of orthopedic infections [4]
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