title: How do porosity-inducing techniques affect antibiotic elution from bone cement? An in vitro comparison between hydrogen peroxide and a mechanical mixer.
abstract: BACKGROUND
  Increasing the porosity of an antibiotic-loaded cement spacer increases the antibiotic elution, but the correlation between porosity and antibiotic elution is not well documented. The purposes of this study was to attempt new porosity-increasing methods and to investigate the correlation between antibiotic elution and both total and surface porosity.
  
  
  METHODS
  Five types of antibiotic-loaded bone cement (ALBC) using 2 g cefazolin and 40 g cement were prepared. Other than manual mixing, hydrogen peroxide was used as a foaming agent and a mixing drill piece was used as a mechanical device to try to induce porosity when mixing the cement. Elution of antibiotic into phosphate-buffered saline was measured from 1 h to 1 week. Surface porosity was calculated from density values which were measured with a density kit and an electronic balance, while total porosity was quantified using micro-computed tomography.
  
  
  RESULTS
  When a mixing drill piece was used to induce porosity, we observed a significant increasin antibiotic elution compared to a manually mixed ALBC. On the other hand, hydrogen peroxide reduced the elution significantly. Mild correlation between the total amount of cluted in 1 week antibiotic elution and total porosity was observed.
  
  
  CONCLUSIONS
  In terms of improving elution, the mixing drill piece seemed to be efficient. A relationship between surface porosity and elution efficacy was not observed.
authors.affiliation: Surgical & Orthopaedic Research Laboratories Prince of Wales Hospital, University of New South Wales Level 1, Clinical Sciences Building, Avoca Street, Randwick, NSW, Australia, 2031, keishiramizu@gmail.com.
authors.forename: K
authors.initials: K
authors.lastname: Shiramizu
authors.forename: V
authors.initials: V
authors.lastname: Lovric
authors.forename: A
authors.initials: A
authors.lastname: Leung
authors.forename: W R
authors.initials: WR
authors.lastname: Walsh