title: Does cyclical loading affect the elution of antibiotics from articulating cement knee spacers?
abstract: Two-stage revision surgery for infected total knee replacement offers the highest rate of success for the elimination of infection. The use of articulating antibiotic-laden cement spacers during the first stage to eradicate infection also allows protection of the soft tissues against excessive scarring and stiffness. We have investigated the effect of cyclical loading of cement spacers on the elution of antibiotics. Femoral and tibial spacers containing vancomycin at a constant concentration and tobramycin of varying concentrations were studied in vitro. The specimens were immersed and loaded cyclically to 250 N, with a flexion excursion of 45°, for 35 000 cycles. The buffered solution was sampled at set intervals and the antibiotic concentration was established so that the elution could be calculated. Unloaded samples were used as a control group for statistical comparison. The elution of tobramycin increased proportionately with its concentration in cement and was significantly higher at all sampling times from five minutes to 1680 minutes in loaded components compared with the control group (p = 0.021 and p = 0.003, respectively). A similar trend was observed with elution of vancomycin, but this failed to reach statistical significance at five, 1320 and 1560 minutes (p = 0.0508, p = 0.067 and p = 0.347, respectively). However, cyclically loaded and control components showed an increased elution of vancomycin with increasing tobramycin concentration in the specimens, despite all components having the same vancomycin concentration. The concentration of tobramycin influences both tobramycin and vancomycin elution from bone cement. Cyclical loading of the cement spacers enhanced the elution of vancomycin and tobramycin.
authors.affiliation: Mount Sinai Hospital, 600 University Avenue, Toronto, Ontario, Canada M5G 1XS. benedictrogers@hotmail.com
authors.forename: B A
authors.initials: BA
authors.lastname: Rogers
authors.forename: F R
authors.initials: FR
authors.lastname: Middleton
authors.forename: N
authors.initials: N
authors.lastname: Shearwood-Porter
authors.forename: S
authors.initials: S
authors.lastname: Kinch
authors.forename: A
authors.initials: A
authors.lastname: Roques
authors.forename: N W
authors.initials: NW
authors.lastname: Bradley
authors.forename: M
authors.initials: M
authors.lastname: Browne
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D019645:Arthroplasty, Replacement, Knee; D001843:Bone Cements / Q000737:chemistry*; D003131:Combined Modality Therapy; D004305:Dose-Response Relationship, Drug; D006801:Humans; D007719:Knee Joint / Q000503:physiopathology; D007720:Knee Prosthesis / Q000009:adverse effects*; D008422:Materials Testing / Q000379:methods; D019904:Polymethyl Methacrylate; D016459:Prosthesis-Related Infections / Q000188:drug therapy* / Q000601:surgery; D012086:Reoperation; D013314:Stress, Mechanical; D014031:Tobramycin / Q000008:administration & dosage; D014640:Vancomycin / Q000008:administration & dosage
chemical_list: D000900:Anti-Bacterial Agents; D001843:Bone Cements; D014640:Vancomycin; D019904:Polymethyl Methacrylate; D014031:Tobramycin