17 research outputs found
The effect of vancomycin addition to the compression strength of antibiotic-loaded bone cements
Lessons learned from early clinical experience and results of 300 ASR® hip resurfacing implantations
Combination of modified mixing technique and low frequency ultrasound to control the elution profile of vancomycin-loaded acrylic bone cement
Comparison of the elution properties of commercially available gentamicin and bone cement containing vancomycin with 'home-made' preparations
Introduction Vancomycin is commonly added to acrylic bone cement during revision arthroplasty surgery. Proprietary cement preparations containing vancomycin are available but significantly more expensive. We investigated whether the antibiotic elution and mechanical strength of ‘home-made’ vancomycin containing bone cement was comparable to commercial vancomycin-impregnated cement.
Methods A total of 18 cement discs of constant size, containing either proprietary CopalG+V®; or ‘home-made’ CopalR+G® with vancomycin added by hand, were made. Each disc contained the same antibiotic quantities (0.5g gentamycin, 2g vancomycin) and was immersed in ammonium acetate buffer in a sealed container. Fluid from each container was sampled at eight time points over a two week period. The concentration of gentamicin and vancomycin in the fluid was analysed using high performance liquid chromatography mass spectrometry. The impact strength of each PMMA cement preparation was measured using a Charpy-type impact tester.
Results Highest peak antibiotic concentrations were observed from the ‘home-made’ vancomycin containing cement, added as in the operating theatre. Overall antibiotic elution was, five-fold (vancomycin) and two-fold (gentamicin), greater from the ‘home-made’ mix compared to commercially mixed cement. However the ‘home-made’ cements showed greater variation in elution kinetics compared to the commercial mix. Use of a vacuum during mixing had no significant effect on antibiotic elution in any of the samples. Impact strength testing showed no significant differences between the groups.
Discussion Our findings suggest the addition of 2g vancomycin powder to gentamicin-impregnated bone cement in theatre, significantly increases elution of both antibiotics, with no significant loss of strength, compared to commercially prepared cement.
Conclusion We have found no significant advantages of expensive off-the-shelf vancomycin-impregnated bone cement and recommend the addition of vancomycin powder by hand when making cement beads and spacers
Limited range of motion of hip resurfacing arthroplasty due to unfavorable ratio of prosthetic head size and femoral neck diameter
The Effects of Interfacial Conditions and Stem Length on Potential Failure Mechanisms in the Uncemented Resurfaced Femur
Groin Pain after Metal on Metal Hip Resurfacing: Mid-Term Follow-Up of a Prospective Cohort of Patients
Femoral Revision with an Extensively Hydroxyapatite-Coated Femoral Component
Between December 1996 and April 2003, 26 consecutive femoral component revisions in 24 patients were performed with an extensively hydroxyapatite-coated femoral stem. Two patients were lost to follow-up, and two patients died of unrelated causes. Of the 22 femoral revisions in 20 patients, there was a 0% incidence of mechanical loosening at average follow-up of 3.2 years (2–6.3 years). The Harris Hip Score improved from 59 (36 to 83) to 95 (84 to 100) postoperatively (p < 0.001). Rate of revision was 18.2% (4.5% for sepsis, 9.1% for instability, and 4.5% for polyethelene wear). All 22 femoral components had evidence of bone ingrowth. The extensively coated hydroxyapatite stem in this series produced excellent clinical results with a low incidence of thigh pain (4.5%) and severe stress shielding (4.5%)