Antibiotics and Bone Cements:Experimental and Clinical Long-Term Observations

Comparing several antibiotics and different bone cements, the mixture of Palacos R (polymethylmethacrylate, PMMA) with gentamicin proved to be the most suitable one as far as a high and sustained release of the antibiotic from the artificial resin is concerned. A continuous leaching of gentamicin was observed for more than 5 years. Gentamicin proved to be stable in Palacos R for the whole period of time. The release of 12 antibiotics from Palacos R was evaluated in vitro. Four other bone cements were included in this study as well, in order to evaluate the leaching of gentamicin from these materials. The combination Gentamicin-Palacos R (GP) showed a 2--3 fold higher and much more prolonged release than did the other mixtures. From this investigation, which also included studies of commercially available antibiotic bone cement mixtures, it is quite obvious that there exist distinct differences in the various bone cements as well as in the various antibiotics as regards their qualification for use in alloarthroplasty. Pharmacokinetic studies in patients after implantation of GP showed low gentamicin concentrations in serum (on average 1.8 microgram/ml) and urine. However, in wound exudate, derived directly from the vicinity of the implanted cement, gentamicin concentrations up to 150 micrograms/ml were observed. Also in tissue samples from the vicinity of the implant, high concentrations were measurable for a long period of time (up to 5 1/2 years).