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. 2019 May 15;12(2):45-49.
eCollection 2019 May.

Effect of Ultrasound Frequency and Treatment Duration on Antibiotic Elution from Polymethylmethacrylate Bone Cement

Alexander C Wendling  1   2 , Damon E Mar  1 , Jonathan C Burkes  1 , Terence E McIff  1
Affiliations

Effect of Ultrasound Frequency and Treatment Duration on Antibiotic Elution from Polymethylmethacrylate Bone Cement

Alexander C Wendling et al. Kans J Med. .

Abstract

Introduction: The objective of this study was to evaluate the effect of ultrasound frequency and treatment duration on antibiotic-impregnated polymethylmethacrylate (PMMA) antibiotic elution rates and mechanical strength.

Methods: Two batches of PMMA were prepared: one with five grams of vancomycin powder and one without. Each batch was divided into two frequency groups: kHz and MHz. Each frequency group was divided into two duration groups: two minutes and ten minutes. Elution samples were measured daily using flow injection analysis. After one week of elution, ultrasound treatments were done daily until each group's average concentration fell below those of non-ultrasound control groups. After elution testing, compression testing determined mechanical properties. Paired t-tests were used to compare daily elution amounts to baseline values. Univariate ANOVAs were used to test for effects of both frequency and treatment duration on antibiotic elution amounts and on mechanical properties.

Results: All ultrasound treatments resulted in significant increases in antibiotic elution. Frequency and duration had significant effects of increasing antibiotic elution (p < 0.001). The kHz group produced significantly greater antibiotic elution than the MHz group (p < 0.001). The 10-minute duration produced significantly greater antibiotic elution than the two-minute duration (both p < 0.001). Frequency and duration did not have significant effects on yield stress (p = 0.841 and p = 0.179, respectively). Frequency had a significant effect (p = 0.024) on modulus, but duration did not (p = 0.136).

Conclusions: Ultrasound frequency and treatment duration significantly affect antibiotic elution from PMMA which may be helpful for treatment of periprosthetic joint infections during revision arthroplasty.

Keywords: anti-bacterial agents; arthroplasty; immunosorbent techniques; prosthesis-related infections; ultrasonography.

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Figures

Figure 1
Figure 1
A cement sample is shown undergoing ultrasound (US) treatment. The specimen is kept in its vile and placed directly on the transducer head with a thin layer of US gel.
Figure 2
Figure 2
Comparison of daily average elution amounts for non-ultrasound (US) controls and all treatment groups. The top figure shows the entire non-US group elution profile and the US treatment groups for their respective treatment durations. The bottom figure shows both non-US and treatment groups but for only the US treatment period which began on day seven. Error bars in the lower plot indicate ± one standard deviation.
Figure 3
Figure 3
Average net sum of the increased vancomycin elution above non-ultrasound (US) elution for combinations of US frequencies and treatment durations. Error bars indicate ± one standard deviation.
Figure 4
Figure 4
Average values are shown for offset yield stress (top) and elastic modulus (bottom) for no-antibiotic and vancomycin-loaded cement samples at the end of each test group’s elution period. Error bars indicate ± one standard deviation.
See this image and copyright information in PMC

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