Liquid gentamicin in bone cement: a laboratory study of a potentially more cost-effective cement spacer.
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.
Seldes
Richard M
RM
Hospital for Special Surgery, New York, NY, USA. rseldes_1999@yahoo.com
Winiarsky
Raz
R
Jordan
Louis C
LC
Baldini
Todd
T
Brause
Barry
B
Zodda
Frank
F
Sculco
Thomas P
TP
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
D000900:Anti-Bacterial Agents; D001843:Bone Cements; D005839:Gentamicins; D019999:Pharmaceutical Solutions; D019904:Polymethyl Methacrylate