Comparison of the elution properties of commercially available gentamicin and bone cement containing vancomycin with ‘home-made’ preparations
2017
Aims Vancomycin is commonly added to acrylic bone cement during revision
arthroplasty surgery. Proprietary cement preparations containing
vancomycin are available, but are significantly more expensive.
We investigated whether the elution of antibiotic from ‘home-made’
cement containing vancomycin was comparable with more expensive
commercially available vancomycin impregnated cement. Materials and Methods A total of 18 cement discs containing either proprietary CopalG+V;
or ‘home-made’ CopalR+G with vancomycin added by hand, were made.
Each disc contained the same amount of antibiotic (0.5 g gentamycin,
2 g vancomycin) and was immersed in ammonium acetate buffer in a
sealed container. Fluid from each container was sampled at eight
time points over a two-week period. The concentrations of gentamicin
and vancomycin in the fluid were analysed using high performance
liquid chromatography mass spectrometry. Results The highest peak concentrations of antibiotic were observed from
the ‘home-made’ cements containing vancomycin, added as in the operating
theatre. The overall elution of antibiotic was, fivefold (vancomycin)
and twofold (gentamicin) greater from the ‘home-made’ mix compared
with the commercially mixed cement. The use of a vacuum during mixing
had no significant effect on antibiotic elution in any of the samples. Conclusion These findings suggest that the addition of 2 g vancomycin powder
to gentamicin-impregnated bone cement by hand significantly increases
the elution of both antibiotics compared with commercially prepared
cements containing vancomycin. We found no significant advantages
of using expensive commercially produced vancomycin-impregnated cement
and recommend the addition of vancomycin powder by hand in the operating theatre. Cite this article: Bone Joint J 2017;99-B:73–7.
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