ArticleBMC musculoskeletal disorders2022
Mechanical strength of antibiotic-loaded PMMA spacers in two-stage revision surgery.
Article in BMC musculoskeletal disorders, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers.
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Who cites it
20 citing papers in PubMed.
- Custom humeral antibiotic spacers for complex shoulder arthroplasty revision: technical principles and case illustrations.JSES reviews, reports, and techniques · 2026Article
- Elution, Porosity, and Mechanical Performance of Vancomycin-Loaded Polymethylmethacrylate (PMMA) Bone Cement.Annals of biomedical engineering · 2026Article
- Impact of surface structuring on antibiotic elution from bone cement in two-stage revision for periprosthetic joint infection.BMC musculoskeletal disorders · 2026Article
- Antimicrobial-loaded PMMA bone cement: time for good practice recommendations.The Journal of antimicrobial chemotherapy · 2026Article
- Clinical and psychosocial impact of limited mobility during the interstage period of two-stage revision arthroplasty for prosthetic joint infection: a state-of-the-art review.Journal of orthopaedic surgery and research · 2026Review
- Clinical Efficacy and Safety of Multiple High-Dose Antibiotic-Loaded Cement Spacers in the Two-Stage Revision of Gram-Positive Periprosthetic Joint Infection.Microorganisms · 2026Article
- The effect of pulsatile lavage on antibiotic elution from bone cements in two-stage revision for periprosthetic joint infection.Journal of orthopaedic surgery and research · 2025Article
- Biomechanical analysis of additional vancomycin in articulating knee spacers: determining the threshold for structural failure.Archives of orthopaedic and trauma surgery · 2025Article
- Eradication of Salmonella enteritidis periprosthetic hip infection using a custom-made articulating spacer: A case report.Joint diseases and related surgery · 2025Article
- Cranioplasty Approaches and Outcomes in Low-Middle Income Countries: A Systematic Review.The Journal of craniofacial surgery · 2025Article
- Single- versus two-stage revision surgery in the case of fracture-related infection: a systematic review.Journal of bone and joint infection · 2025Review
- High and Low Dosage of Vancomycin in Polymethylmethacrylate Cements: Efficacy and Mechanical Properties.Antibiotics (Basel, Switzerland) · 2024Article
- Acetabular Screws With Cement Augment for Tibial Plateau Defects in Dynamic Spacer Implantation: A Case of Recalcitrant Native Knee Septic Arthritis.Arthroplasty today · 2024Article
- Surgical Management of Periprosthetic Joint Infections in Hip and Knee Megaprostheses.Medicina (Kaunas, Lithuania) · 2024Review
- Investigation of mechanical behavior on the cement hip spacer geometry under finite element method and compression load test.Journal of orthopaedics · 2024Review
- Enhanced antibiotic release from bone cement spacers utilizing dual antibiotic loading with elevated vancomycin concentrations in two-stage revision for periprosthetic joint infection.International orthopaedics · 2023Article
- Daptomycin-Impregnated PMMA Cement against Vancomycin-Resistant Germs: Dosage, Handling, Elution, Mechanical Stability, and Effectiveness.Antibiotics (Basel, Switzerland) · 2023Article
- Breaking Barriers in Cranioplasty: 3D Printing in Low and Middle-Income Settings-Insights from Zenica, Bosnia and Herzegovina.Medicina (Kaunas, Lithuania) · 2023Observational
- Temporary arthrodesis through static spacer implantation in two-stage treatment of periprosthetic joint infections of the knee.Operative Orthopadie und Traumatologie · 2023Review
- PLLA Coating of Lyophilized Human Bone Allograft for Long-term Release of Antibiotics.In vivo (Athens, Greece)Article
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Authors and funding
6 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundAntibiotic-loaded polymethylmethacrylate (PMMA) bone cement spacers provide high local antibiotic concentrations and patient mobility during the interim period of two-stage revision for periprosthetic joint infection (PJI). This study compares mechanical characteristics of six dual antibiotic-loaded bone cement (dALBC) preparations made from three different PMMA bone cements. The study`s main objective was to determine the effect of time and antibiotic concentration on mechanical strength of dALBCs frequently used for spacer fabrication in the setting of two-stage revision for PJI.
methodsA total of 84 dual antibiotic-loaded bone cement specimens made of either Copal spacem, Copal G + V or Palacos R + G were fabricated. Each specimen contained 0.5 g of gentamicin and either 2 g (low concentration) or 4 g (high concentration) of vancomycin powder per 40 g bone cement. The bending strength was determined at two different timepoints, 24 h and six weeks after spacer fabrication, using the four-point bending test.
resultsPreparations made from Copal G + V showed the highest bending strength after incubation for 24 h with a mean of 57.6 ± 1.2 MPa (low concentration) and 50.4 ± 4.4 MPa (high concentration). After incubation for six weeks the bending strength had decreased in all six preparations and Palacos R + G showed the highest bending strength in the high concentration group (39.4 ± 1.6 MPa). All low concentration preparations showed superior mechanical strength compared to their high concentration (4 g of vancomycin) counterpart. This difference was statistically significant for Copal spacem and Copal G + V (both p < 0.001), but not for Palacos R + G (p = 0.09).
conclusionsThis study suggests that mechanical strength of antibiotic-loaded PMMA bone cement critically decreases even over the short time period of six weeks, which is the recommended interim period in the setting of two-stage revision. This potentially results in an increased risk for PMMA spacer fracture at the end of the interim period and especially in patients with prolonged interim periods. Finally, we conclude that intraoperative addition of 4 g of vancomycin powder per 40 g of gentamicin-premixed Palacos R + G (Group D) is mechanically the preparation of choice if a dual antibiotic-loaded bone cement spacer with high antibiotic concentrations and good stability is warranted. In any case the written and signed informed consent including the off-label use of custom-made antibiotic-loaded PMMA bone cement spacers must be obtained before surgery.
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