In vitro elution characteristics of gentamicin- and teicoplanin-loaded CMW1 and Palacos R bone cement

Abstract

Purpose: To compare the in vitro elution characteristics of CMW1 and Palacos R bone cement loaded with gentamicin, teicoplanin, or in combination.

Methods: Four bone cement discs were prepared for each cement type. Disc 1 contained no antibiotics; disc 2 contained 0.5 g gentamicin; disc 3 contained 2 g teicoplanin; disc 4 contained 0.5 g gentamicin and 2 g teicoplanin. Elution studies were conducted using a fluorescence polarisation immunoassay technique and performed at intervals of 6 weeks.

Results: For CMW1, gentamicin and teicoplanin elution levels in combination discs were higher than those in the single antibiotic discs (p < 0.001 & p < 0.06). For Palacos R, gentamicin elution levels in combination discs were higher than those in the single antibiotic discs (p < 0.001), but teicoplanin elution levels in combination discs were lesser than that from the single antibiotic discs (p < 0.02). In single and combination discs, gentamicin elution levels in Palacos R were higher than those in CMW1 (p < 0.001 & p < 0.001). Palacos R eluted more teicoplanin than CMW1, except in combined disc with gentamicin, when less teicoplanin was eluted.

Conclusion: Antibiotic elution is higher in Palacos R than CMW1. Antibiotic combination in both cement types has the synergistic effect of increasing antibiotic elution, except for teicoplanin from Palacos R. When high elution of gentamicin is required, Palacos R is preferable. When high elution of teicoplanin is required, Palacos R with only teicoplanin is superior to CMW1.

Keywords: Antibiotic elution; Arthroplasty; Bone cement; CMW; Palacos.

Fig. 1

Elution profiles of the log antibiotic measures from each disc type at each time point. These figures clearly show that there is a greater level of variability for gentamicin than for teicoplanin. CMW1 – Single, CMW1 cement disc loaded with a single antibiotic; CMW1 – Comb., CMW1 cement disc loaded with a combination of antibiotics; PAL–R – Single, Palacos R cement disc loaded with a single antibiotic; PAL–R – Comb., Palacos R cement loaded with a combination of antibiotics.

Fig. 2

Gentamicin elution levels from CMW1 cement discs loaded with only gentamicin (blue) and a combination of gentamicin and teicoplanin (red).

Fig. 3

Teicoplanin elution levels from CMW1 cement discs loaded with only teicoplanin (blue) and a combination of gentamicin and teicoplanin (red).

Fig. 4

Gentamicin elution levels from Palacos R cement discs loaded with only gentamicin (blue) and a combination of gentamicin and teicoplanin (red).

Fig. 5

Teicoplanin elution levels from Palacos R cement discs loaded with only teicoplanin (blue) and a combination of gentamicin and teicoplanin (red).

Fig. 6

Total gentamicin elution levels for 6 weeks from Palacos R and CMW1 cement discs loaded with only gentamicin (blue) and a combination of gentamicin and teicoplanin (red).

Fig. 7

Total teicoplanin elution levels for 6 weeks from Palacos R and CMW1 cement discs loaded with only teicoplanin (blue) and a combination of gentamicin and teicoplanin (red).