Abstract
BackgroundThis biomechanical study evaluates the effect of N-acetylcysteine alone and in combination with the most commonly used antibiotic-loaded bone cement mixtures.MethodsWe mixed eight bone cement mixture groups including combinations of N-acetylcysteine, gentamicin, teicoplanin, and vancomycin and applied a four-point bending test individually to each sample on days 1 and 15 using an MTS Acumen test device.ResultsThe result was less than 50 MPa—the limit declared by the ISO (International Standards Organization)—in only the “gentamicin + bone cement + N-acetylcysteine” group. Mechanical fatigue resistance of the bone cement decreased significantly with the addition of N-acetylcysteine both on day 1 and day 15 (p < 0.001). With the addition of N-acetylcysteine into the “gentamicin + bone cement” and “vancomycin + bone cement” mixtures, a significant decrease in mechanical fatigue resistance was observed both on day 1 and day 15 (p < 0.001). In contrast, with the addition of N-acetylcysteine into the “teicoplanin + bone cement” mixture, no significant difference in mechanical fatigue resistance was observed on days 1 and 15 (p = 0.093, p = 0.356).ConclusionPreliminary results indicate that adding N-acetylcysteine to teicoplanin-loaded bone cement does not significantly affect the cement’s mechanical resistance, potentially leading to a new avenue for preventing and treating peri-prosthetic joint infection. N-acetylcysteine may, therefore, be considered as an alternative agent to be added to antibiotic-loaded bone cement mixtures used in the prevention of peri-prosthetic joint infection.
Highlights
This biomechanical study evaluates the effect of N-acetylcysteine alone and in combination with the most commonly used antibiotic-loaded bone cement mixtures
Antibiotic-loaded bone cement (ALBC) prophylaxis promises to be an effective strategy towards reducing the risk of infection following total joint arthroplasty (TJA) [2] and is commonly used for high-dose local delivery of antibiotics to the
Biofilm formation is a bacterial behavior that impedes the effectiveness of prosthetic joint infection (PJI) therapy [5], and inadequate ALBC application may lead to the proliferation of resistant bacteria strains and cannot obviate biofilm formation [12]
Summary
This biomechanical study evaluates the effect of N-acetylcysteine alone and in combination with the most commonly used antibiotic-loaded bone cement mixtures. Antibiotic-loaded bone cement (ALBC) prophylaxis promises to be an effective strategy towards reducing the risk of infection following TJA [2] and is commonly used for high-dose local delivery of antibiotics to the. Studies have shown that NAC reduces biofilm formation, inhibits bacterial adherence, and decreases the production of extracellular polysaccharide matrix and cell viability [7,8,9,10]. Since NAC exhibits a synergistic antibacterial and anti-biofilm activity, the proposed study has been designed to evaluate its effects on the mechanical properties of bone cement when used exclusively as well as in combination with commonly used antibiotic mixtures, such as gentamicin, teicoplanin, and vancomycin. It has been hypothesized that its addition would cast a curtailing effect on the biomechanical properties of bone cement, and its combination with antibiotics causes further aggravation of this effect
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
