Tao Li,1,* Lilan Fu,2,* Jian Wang,1 Zhanjun Shi11Department of Orthopedics, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, People’s Republic of China; 2Nanfang PET Center, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, People’s Republic of China*These authors contributed equally to this workPurpose: Low doses of vancomycin and gentamicin were commonly incorporated into acrylic bone cement (antibiotic-impregnated bone cement, AIBC) during revision arthroplasty.Previous studies showed that only a very small amount of antibiotics could be eluted from AIBC.Given the fact that a high dose of antibiotic would elute high concentration of antibiotic, this study investigated the influence of a high dose of dual-antibiotic loading on the properties of cement.Methods: A total of 8 groups of AIBC containing either gentamicin or vancomycin or both with different amounts of antibiotics (1 g, 2 g and 4 g) were Copricuscini tested on material properties, elution profiles, antibacterial activity and cytological toxicity.Results: A high dose of gentamicin and vancomycin AIBC (with 2 g gentamicin and 2 g vancomycin Pet Edible loaded) regiment showed acceptable compressive strength of 74.
25±0.72 MPa.No cytotoxicity or antibacterial activity reduction was observed in any group tested in this study.The elution profiles indicated that incorporating 2 g vancomycin resulted in 4.77% (1049.
57±3.74 μg) released after 28 days.However, after 2 g gentamicin was added, the vancomycin released was significantly reduced to 2.42% (532.24±1.
77 μg) (p<0.001), approximately 50% reduction.No significant influence of vancomycin on gentamicin was observed.Conclusion: These findings suggest that the addition of 2 g vancomycin and 2 g gentamicin into acrylic bone cement was preferred while considering this dual-antibiotic AIBC regiment with acceptably material properties and effective antibacterial activity.However, special attention should be drawn to the reduction of vancomycin elution when incorporated with gentamicin.
Keywords: antibiotic impregnated bone cement, elution, mechanical characteristic, antibacterial activity, toxicity.