A simple method to improve the antibiotic elution profiles from polymethylmethacrylate bone cement spacers by using rapid absorbable sutures
Abstract Objective Antibiotic-loaded bone cement beads and spacers have been widely used for orthopaedic infection. Poor antibiotic elution is not capable of eradicating microbial pathogens and could lead to treatment failure. The elution profiles differ among different cement formulations. Although...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2022-10-01
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| Series: | BMC Musculoskeletal Disorders |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12891-022-05870-0 |
| _version_ | 1811182284293799936 |
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| author | Tzu-Hao Tseng Chih-Hao Chang Chien-Lin Chen Hongsen Chiang Hao-Ying Hsieh Jyh-Horng Wang Tai-Horng Young |
| author_facet | Tzu-Hao Tseng Chih-Hao Chang Chien-Lin Chen Hongsen Chiang Hao-Ying Hsieh Jyh-Horng Wang Tai-Horng Young |
| author_sort | Tzu-Hao Tseng |
| collection | DOAJ |
| description | Abstract Objective Antibiotic-loaded bone cement beads and spacers have been widely used for orthopaedic infection. Poor antibiotic elution is not capable of eradicating microbial pathogens and could lead to treatment failure. The elution profiles differ among different cement formulations. Although Simplex P cement has the least release amount, it is widely used due to its ready availability. Previous methods aiming to improve the elution profiles were not translated well to clinical practice. We sought to address this by using easily available materials to improve the elution profile of antibiotics from PMMA, which allows clinicians to implement the method intraoperatively. Methods Vancomycin was mixed with Simplex P cement. We used Vicryl Rapide sutures to fabricate sustained-release cement beads by repetitively passing the sutures through the beads and/or mixing suture segments into the cement formulation. Vancomycin elution was measured for 49 days. The mechanism of antibiotic release was observed with gross appearance and scanning electron microscopic images. The antimicrobial activities against MRSA were tested using an agar disk diffusion bioassay. Results Passing Vicryl Rapide sutures through cement beads significantly improved the elution profiles in the 7-week period. The increased ratios were 9.0% on the first day and 118.0% from the 2nd day to the 49th day. Addition of suture segments did not increase release amount. The Vicryl Rapide sutures completely degraded at the periphery and partially degraded at the center. The antibiotic particles were released around the suture, while antibiotic particles kept densely entrapped in the control group. The antimicrobial activities were stronger in passing suture groups. Conclusion Passing fast absorbable sutures through PMMA cement is a feasible method to fabricate sustained-release antibiotic bone cement. Intra-cement tunnels can be formed, and the effect can last for at least 7 weeks. It is suitable for a temporary spacer between two stages of a revision surgery. |
| first_indexed | 2024-04-11T09:30:17Z |
| format | Article |
| id | doaj.art-83c9fe8f72bf4464b87f48ce5efc0df0 |
| institution | Directory Open Access Journal |
| issn | 1471-2474 |
| language | English |
| last_indexed | 2024-04-11T09:30:17Z |
| publishDate | 2022-10-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Musculoskeletal Disorders |
| spelling | doaj.art-83c9fe8f72bf4464b87f48ce5efc0df02022-12-22T04:31:55ZengBMCBMC Musculoskeletal Disorders1471-24742022-10-0123111310.1186/s12891-022-05870-0A simple method to improve the antibiotic elution profiles from polymethylmethacrylate bone cement spacers by using rapid absorbable suturesTzu-Hao Tseng0Chih-Hao Chang1Chien-Lin Chen2Hongsen Chiang3Hao-Ying Hsieh4Jyh-Horng Wang5Tai-Horng Young6Department of Biomedical Engineering, National Taiwan UniversityDepartment of Orthopaedic Surgery, National Taiwan University HospitalDepartment of Biomedical Engineering, National Taiwan UniversityDepartment of Orthopaedic Surgery, National Taiwan University HospitalDepartment of Biomedical Engineering, National Taiwan UniversityDepartment of Orthopaedic Surgery, National Taiwan University HospitalDepartment of Biomedical Engineering, National Taiwan UniversityAbstract Objective Antibiotic-loaded bone cement beads and spacers have been widely used for orthopaedic infection. Poor antibiotic elution is not capable of eradicating microbial pathogens and could lead to treatment failure. The elution profiles differ among different cement formulations. Although Simplex P cement has the least release amount, it is widely used due to its ready availability. Previous methods aiming to improve the elution profiles were not translated well to clinical practice. We sought to address this by using easily available materials to improve the elution profile of antibiotics from PMMA, which allows clinicians to implement the method intraoperatively. Methods Vancomycin was mixed with Simplex P cement. We used Vicryl Rapide sutures to fabricate sustained-release cement beads by repetitively passing the sutures through the beads and/or mixing suture segments into the cement formulation. Vancomycin elution was measured for 49 days. The mechanism of antibiotic release was observed with gross appearance and scanning electron microscopic images. The antimicrobial activities against MRSA were tested using an agar disk diffusion bioassay. Results Passing Vicryl Rapide sutures through cement beads significantly improved the elution profiles in the 7-week period. The increased ratios were 9.0% on the first day and 118.0% from the 2nd day to the 49th day. Addition of suture segments did not increase release amount. The Vicryl Rapide sutures completely degraded at the periphery and partially degraded at the center. The antibiotic particles were released around the suture, while antibiotic particles kept densely entrapped in the control group. The antimicrobial activities were stronger in passing suture groups. Conclusion Passing fast absorbable sutures through PMMA cement is a feasible method to fabricate sustained-release antibiotic bone cement. Intra-cement tunnels can be formed, and the effect can last for at least 7 weeks. It is suitable for a temporary spacer between two stages of a revision surgery.https://doi.org/10.1186/s12891-022-05870-0PMMACementReleaseInfectionAntibiotics |
| spellingShingle | Tzu-Hao Tseng Chih-Hao Chang Chien-Lin Chen Hongsen Chiang Hao-Ying Hsieh Jyh-Horng Wang Tai-Horng Young A simple method to improve the antibiotic elution profiles from polymethylmethacrylate bone cement spacers by using rapid absorbable sutures BMC Musculoskeletal Disorders PMMA Cement Release Infection Antibiotics |
| title | A simple method to improve the antibiotic elution profiles from polymethylmethacrylate bone cement spacers by using rapid absorbable sutures |
| title_full | A simple method to improve the antibiotic elution profiles from polymethylmethacrylate bone cement spacers by using rapid absorbable sutures |
| title_fullStr | A simple method to improve the antibiotic elution profiles from polymethylmethacrylate bone cement spacers by using rapid absorbable sutures |
| title_full_unstemmed | A simple method to improve the antibiotic elution profiles from polymethylmethacrylate bone cement spacers by using rapid absorbable sutures |
| title_short | A simple method to improve the antibiotic elution profiles from polymethylmethacrylate bone cement spacers by using rapid absorbable sutures |
| title_sort | simple method to improve the antibiotic elution profiles from polymethylmethacrylate bone cement spacers by using rapid absorbable sutures |
| topic | PMMA Cement Release Infection Antibiotics |
| url | https://doi.org/10.1186/s12891-022-05870-0 |
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