title: Liquid gentamicin in bone cement: a laboratory study of a potentially more cost-effective cement spacer.
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.
authors.affiliation: Hospital for Special Surgery, New York, NY, USA. rseldes_1999@yahoo.com
authors.forename: Richard M
authors.initials: RM
authors.lastname: Seldes
authors.forename: Raz
authors.initials: R
authors.lastname: Winiarsky
authors.forename: Louis C
authors.initials: LC
authors.lastname: Jordan
authors.forename: Todd
authors.initials: T
authors.lastname: Baldini
authors.forename: Barry
authors.initials: B
authors.lastname: Brause
authors.forename: Frank
authors.initials: F
authors.lastname: Zodda
authors.forename: Thomas P
authors.initials: TP
authors.lastname: Sculco
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000191:economics; D001843:Bone Cements / Q000191:economics; D019245:Compressive Strength / Q000187:drug effects; D003362:Cost-Benefit Analysis; D016503:Drug Delivery Systems; D004926:Escherichia coli / Q000187:drug effects; D005839:Gentamicins / Q000008:administration & dosage* / Q000191:economics; D006801:Humans; D008422:Materials Testing; D019999:Pharmaceutical Solutions; D019904:Polymethyl Methacrylate / Q000191:economics; D013718:Tensile Strength / Q000187:drug effects
chemical_list: D000900:Anti-Bacterial Agents; D001843:Bone Cements; D005839:Gentamicins; D019999:Pharmaceutical Solutions; D019904:Polymethyl Methacrylate