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Liquid Gentamicin in Bone Cement: A Laboratory Study of a Potentially More Cost-Effective Cement Spacer
Richard M. Seldes, MD1; Raz Winiarsky, MD2; Louis C. Jordan, MD3; Todd Baldini, BS, MS4; Barry Brause, MD5; Frank Zodda, MS6; Thomas P. Sculco, MD6
1 Department of Orthopedic Surgery, Forest Hills Hospital, 102-01 66th Road, 2nd Floor, Forest Hills, NY 11375. E-mail address: rseldes_1999@yahoo.com
2 280 Riverside Drive, New York, NY 10025
3 Jordan-Young Institute, 5501 Greenwich Road, Suite 200, Virginia Beach, VA 23462
4 University of Colorado HSC at Fitzsimmons, 12101 East Colfax Avenue, MS F-432, Aurora, CO 80045
5 215 East 68th Street, New York, NY 10021
6 Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021
View Disclosures and Other Information
The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.
Investigation performed at the Hospital for Special Surgery, New York, NY

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2005 Feb 01;87(2):268-272. doi: 10.2106/JBJS.C.00728
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Abstract

Background: Liquid gentamicin is approved by the Food and Drug Administration, is readily available, and is much less costly than tobramycin, the more commonly used antibiotic in cement spacers. The purpose of the present study was to test the mechanical properties, elution characteristics, and antibacterial activity of liquid gentamicin in an acrylic bone cement spacer.

Methods: Standardized specimens consisting of Palacos cement combined with liquid gentamicin, powdered tobramycin, or no antibiotic were fashioned, and the three groups were tested with regard to compressive and tensile strength, elution characteristics (with use of radioimmunoassays), and antibacterial activity (with use of bioassays).

Results: The ultimate compression strength decreased by 49% (from 64.65 ± 3.89 MPa to 32.96 ± 3.33 MPa) and the ultimate tension strength decreased by 46% (from 35.85 ± 2.97 MPa to 19.20 ± 0.36 MPa) when the specimens containing 480 mg of liquid gentamicin were compared with the controls. The addition of tobramycin had no significant effect compared with the controls. The majority of gentamicin was released from the cement during the initial twenty-four hours (mean concentration, 26.4 mcg/mL). The mean concentrations at three and six weeks were 4.15 and 0.65 mcg/mL, respectively. The bioassays confirmed the bactericidal activity of the gentamicin released from the cement.

Conclusions: Liquid gentamicin in bone cement is potent and bactericidal. Although the mechanical properties of the cement are significantly diminished by the addition of liquid gentamicin, the temporary nature of the cement spacer makes its use potentially worthwhile given the substantial cost savings to the hospital and the patient.

Clinical Relevance: Substantial health-care dollars could be saved by the use of liquid gentamicin in cement spacers that are employed for the treatment of infection following total joint arthroplasty. Additional studies are needed to determine the clinical efficacy and safety of such treatment.

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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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