In vitro elution characteristics of gentamicin- and teicoplanin-loaded CMW1 and Palacos R bone cement

M Nagy; C Jakaraddi; T Neal; R Jackson; A Navin; J S Davidson; A J A Santini

doi:10.1016/j.jor.2021.03.024

In vitro elution characteristics of gentamicin- and teicoplanin-loaded CMW1 and Palacos R bone cement

J Orthop. 2021 Apr 15:25:75-81. doi: 10.1016/j.jor.2021.03.024. eCollection 2021 May-Jun.

Authors

M Nagy¹, C Jakaraddi¹, T Neal², R Jackson³, A Navin¹, J S Davidson¹, A J A Santini^{1

4}

Affiliations

¹ Lower Limb Arthroplasty Unit, Department of Trauma and Orthopaedic Surgery, Liverpool University Hospitals, Liverpool, UK.
² Department of Microbiology, Liverpool University Hospitals, Liverpool, UK.
³ Liverpool Cancer Trial Centre, Statistical Department, University of Liverpool, UK.
⁴ Faculty of Health and Life Sciences, University of Liverpool, UK.

Abstract

Purpose: To compare the in vitro elution characteristics of CMW1 and Palacos R bone cement loaded with gentamicin, teicoplanin, or in combination.

Methods: Four bone cement discs were prepared for each cement type. Disc 1 contained no antibiotics; disc 2 contained 0.5 g gentamicin; disc 3 contained 2 g teicoplanin; disc 4 contained 0.5 g gentamicin and 2 g teicoplanin. Elution studies were conducted using a fluorescence polarisation immunoassay technique and performed at intervals of 6 weeks.

Results: For CMW1, gentamicin and teicoplanin elution levels in combination discs were higher than those in the single antibiotic discs (p < 0.001 & p < 0.06). For Palacos R, gentamicin elution levels in combination discs were higher than those in the single antibiotic discs (p < 0.001), but teicoplanin elution levels in combination discs were lesser than that from the single antibiotic discs (p < 0.02). In single and combination discs, gentamicin elution levels in Palacos R were higher than those in CMW1 (p < 0.001 & p < 0.001). Palacos R eluted more teicoplanin than CMW1, except in combined disc with gentamicin, when less teicoplanin was eluted.

Conclusion: Antibiotic elution is higher in Palacos R than CMW1. Antibiotic combination in both cement types has the synergistic effect of increasing antibiotic elution, except for teicoplanin from Palacos R. When high elution of gentamicin is required, Palacos R is preferable. When high elution of teicoplanin is required, Palacos R with only teicoplanin is superior to CMW1.

Keywords: Antibiotic elution; Arthroplasty; Bone cement; CMW; Palacos.