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Antibiotic Loaded Cement

Antiobiotic Loaded Cement

Rationale

antibiotic released
High local concentrations
More than with systemic treatment
More than MIC
Low systemic concentrations
Minimal side effects

Antibiotic

Must be heat-resistant
Must be in powder form
Bugs sensitive to antibiotic
Gentamicin
Vancomycin
Can’t use tetracycline, lincomycin, rifampicin or chloramphenicol
- Degraded by exothermic curing reaction

Amount

< 4g can be added without significantly altering strength
0.5-2g usually added to 40g powder & 20ml fluid
Recommendations
- 0.6-1.2g tobramycin
- 0.5-1.0g vancomycin
- Per 40g batch cement

Release

Elution highest in first few hours
Decays with time
May be present for 6/52
Elution rate varies with
- Type of antibiotic
- Concentration of antibiotic
- Porosity of cement

Uses

Primary THR

antibiotic loaded cement used to secure component
Used ± systemic antibiotics
Role uncertain
- Josefsson et al Clin Ortho 1993
  - Randomized trial
    - 1688 patients primary implant
    - Systemic vs Cement antibiotic
    - No statistically significant difference
    - Suggested combined use preferential
- Espehaug et al JBJS95
  - Palacos + Garamycin
  - Higher levels of antibiotic elution
  - Higher surface porosity
  - Most resistant to fracture

Revision THR

Cement

antibiotic Loaded cement used to secure component
No excellent studies
Seems that it is superior
Decreased failure rate with 2 & 1 stage by 10%

Beads

Cement beads used to fill space
Can use greater amounts of cement
Drug delivery system
No structural strength required

Spacer

antibiotic loaded temporary cement spacer
Complexity varies
All-Cement Thompson-type
Stainless-steel endoskeleton coated with cement
Prevents shortening & may allow mobilization
Results as good as or better than without
Success in 93.5% of cases